"Heart failure patients may become noncompliant with their congestive heart failure (CHF) treatment if they feel it causes or aggravates their ED," Bocchi says. "However, our study suggests that treating the ED may make patients more motivated to take their medicines."

Sildenafil caused no harmful effects and improved exercise performance during treadmill exercise tests in 23 men with CHF (average age 50) and a history of ED, says Bocchi.

Sildenafil blocks the activity of the enzyme phosphodiesterase type 5 (PDE5), which is active in multiple tissues and cells. The effects of PDE5 inhibition include increased production of nitric oxide, which is associated with improved function of the heart and blood vessels.

The cardiovascular effects of sildenafil have created some concern that the drug might be harmful in men with CHF. But there's not enough data on the safety or potential harm of sildenafil in CHF patients.

Most of the men had moderate or severe heart failure, and each had been referred for treatment of ED. On separate days, the men underwent two exercise treadmill tests, which consisted of a six-minute walk and a maximal exercise test. About an hour before the first test, the men received either 50 milligrams of sildenafil or a placebo. On the second day, the men received the opposite treatment (sildenafil or placebo) before exercise.

Those treated with sildenafil had significantly lower blood pressure and heart rate and improvement in measures of oxygen consumption and carbon dioxide production compared with those on placebo. Total exercise time also increased significantly. A separate evaluation showed that treatment with sildenafil was associated with higher scores on a questionnaire related to erectile function.

"Frequently, CHF patients, and especially their wives, are afraid their spouses will have heart failure symptoms or even death during sexual activity," says Bocchi. "Our study shows that the benefits may outweigh harmful side effects of treatment with sildenafil. The successful treatment of ED in CHF could not only improve sexual relationships but overall quality and success of CHF treatment."

"Our study suggests, that erectile dysfunction, particularly in young men, may be an early warning sign of heart disease and stroke," says MUHC Director of Clinical Epidemiology, Dr. Steven Grover.

Dr. Grover, who is also a professor in the Faculty of Medicine at McGill University, and his colleagues evaluated more than 4 000 men. They compared the risk of erectile dysfunction among patients with and without cardiovascular disease. "We found that the presence of cardiovascular disease was strongly associated with erectile dysfunction," says Dr. Grover.

Among men without diagnosed cardiovascular disease, cardiovascular risk factors such as diabetes, smoking, high blood pressure and low HDL cholesterol were more common among those who had erectile dysfunction. This suggests that the men who have erectile dysfunction and have no other symptoms of cardiovascular disease may be at increased risk for developing the disease. Grover said that a complete diagnostic evaluation of erectile dysfunction should include screening for cardiovascular risk factors.

The study, appearing in the Journal of Neuro-ophthalmology, looked at seven men, aged between 50 and 69 years, who had typical features of NAION within 36 hours of taking Viagra for erectile dysfunction. Similar cases have been reported in the past.

"For years, we've known that some men who take Viagra will experience temporary color changes in their vision and see things as blue or green," said Howard Pomeranz, at the University of Minnesota Medical School. "NAION is a much more serious condition because it can lead to permanent vision loss." All of the patients had at least one arteriosclerotic risk factor, including hypertension, diabetes, hypercholesterolemia, or hyperlipidemia. All of the patients also had a low cup to disk ratio, which means that the blood vessels and nerves are tightly bundled together into the small space in the back of the eye.

The researchers believe that ophthalmologists should ask all men with NAION about the use of Viagra, and recommend that patients with a history of NAION in one eye be cautioned that Viagra may increase the risk of NAION in the other eye. "Viagra regulates a chemical in the body to constrict the arteries. This constriction may cut off the blood flow to the optic nerve, especially in people with a low cup to disk ratio, where the blood vessels and nerves are tightly bundled provoking NAION," concluded Pomeranz.

Researcher Emilio Chiurlia, from the University of Modena in Italy, said erectile dysfunction appeared to be a reliable early warning system for coronary disease. "We think that erectile dysfunction represents the 'tip of the iceberg' of a systemic vascular disorder; thus potentially preceding severe cardiovascular events. Erectile dysfunction should be part of a cardiovascular risk assessment. These patients should be considered at high risk for coronary artery disease and should have high priority for aggressive treatment."

The study, published in the Journal of the American College of Cardiology, looked at two groups of men with similar coronary risk factors. The difference was that one group suffered from erectile dysfunction while the other group did not. The researchers found that the men with erectile dysfunction had higher levels of C-reactive protein (an indicator of coronary risk). Additionally, they were also more likely to have abnormal blood vessel responses to changes in blood flow and more of them had coronary artery calcifications.

Chiurlia said erectile dysfunction should raise doctor's suspicions about early coronary disease, even in men who would not otherwise be considered at high risk. "When a man is diagnosed with erectile dysfunction, clinicians should be aware that erectile dysfunction could represent an early clinical manifestation of a diffuse sub-clinical vascular disease and coronary artery disease. The smaller penile arteries suffer obstruction from plaque burden earlier than the larger coronary arteries hence erectile dysfunction may be symptomatic before a coronary event."

While the study involved only a small number of men, other researchers agreed that the findings could have major implications for the diagnosis of coronary disease. "The present study… lends strong support to the notion that erectile dysfunction may be an early warning sign of clinically-silent coronary artery disease. …it is a strength of the present work that it assesses major aspects connecting erectile dysfunction and more generalized vascular disease in one study," Dr. Renke Maas, from the University-Hospital in Hamburg, noted.

Chiurlia urged that more research should be undertaken. "We need prospective studies addressing the precise role of erectile dysfunction as a marker of cardiovascular disease," he concluded.

But men choosing to treat erectile dysfunction with prosthetic implant surgery often have concerns about loss of penis length following the surgery. Now, however, a new study has found that a simple surgical technique performed at the time of implantation can maintain penile length, and in some cases, actually lengthen the penis.

The research was based on over 300 erectile dysfunction patients who underwent surgery to have a three-piece inflatable penile prosthesis (IPP) inserted. To address the possible loss of penile length, the surgeons involved performed a procedure at the same time that released the suspensory ligament that anchors the penis. The procedure is a well documented technique that is also used in penile augmentation surgery.

The results from the study showed that the release of the suspensory ligament during IPP implant surgery can maintain penile length. The findings were based on patient satisfaction with penile length after IPP surgery and a substudy that measured the patient's penile length after IPP implantation, both before and after suspensory ligament release.

The actual figures showed over 90 percent of the patients reporting satisfaction with IPP performance and penile length. Importantly, none of the patients reported penile shortening, and in fact, some of them reported an increase in penile length, as compared with preoperative measurements.

For men considering a prosthetic implant, the study's authors suggest that they should also consider the release of the suspensory ligament which would allow them to maintain, or even increase, penile length, with a minimum of complications.

The findings come from prescribing data for nearly 12,000 patients collected by the National Health Service. The data was gathered from questionnaires that ask doctors to record any significant events recorded in a patient's notes after prescribing newly marketed medicines.

In the case of Uprima, 65 percent of doctors who responded said their patient stopped taking Uprima because the patient felt it wasn't effective. Further analysis showed that 59 percent of patients who didn't find it effective stopped taking Uprima after a month and a further 23 percent had joined them by the second month.

The doctors themselves seemed to mirror their patients' sentiments, with 70 percent saying they didn't think the drug was effective. The average age of the patients was 61 and most patients (99 percent) received the manufacturer's recommended dose of 2-3mg, with the remainder receiving between 4-12mg.

The results of the survey showed that surveillance on a national scale after new drugs were launched was a valuable exercise, explained lead researcher Professor Saad Shakir. "Because family doctors are not approached before the decision to treat a patient has been made, they are not subject to detailed inclusion or exclusion criteria. The decision to prescribe is made purely as a result of their clinical knowledge of the patient and the drug involved. The result is real world clinical data that provides information of illness and death in patients treated with newly marketed drugs - a valuable tool in drug safety assessment," said Prof. Shakir.

Known as the "love hormone" or "cuddle chemical," oxytocin plays several important roles in social interactions and reproduction, including triggering uterine contractions and lactation. It is also released during orgasm and has been linked to sexual arousal.

The finding is the first indication of a chemical mechanism through which erectile dysfunction drugs like Viagra may have physical effects besides increasing blood flow to sexual organs, says study author Meyer Jackson, a physiology professor at UW-Madison.

Sildenafil seems to boost oxytocin by increasing blood flow to the posterior pituitary. "I think this is a missing link in terms of trying to sort out the issues around whether there are additional effects of phosphodiesterase type 5 inhibitors [Viagra, Levitra and Cialis]," said Jackson.

The new study, appearing in the Journal of Physiology, involved measuring oxytocin released from rat pituitaries in response to neural stimulation. When the pituitaries were treated with sildenafil, they responded to the stimulation by releasing three times as much oxytocin as they did without the drug. Importantly, the drug had little if any effect on hormone release in the absence of stimulation.

Jackson doesn't think his findings raise any significant safety issues related to Viagra use, but he does think it provides strong rationale for studies of additional effects and new potential uses. "A big question raised by our study is, will sildenafil do the same thing to the nerve terminals that release oxytocin [in the brain]," he noted. Though sildenafil's effects on these pathways are still unknown, work by other researchers has shown that oxytocin-sensitive cells in the brain play a role in the neural control of erectile responses, suggesting that Viagra and its kin may work through multiple channels.

The little blue pills could have other uses as well. Oxytocin has been linked to the ability to make strong social bonds, while sildenafil was recently shown to improve hamsters' abilities to adjust the timing of their internal clocks to overcome simulated jet lag. "It raises the possibility that erectile dysfunction drugs could be doing more than just affecting erectile dysfunction," mused Jackson.

The papers touted this as the "first ever testicle transplant." They were wrong about this in two respects: 1) This was technically not a transplant, it was a re-plant; and 2) It wasn't the first, not even close. According to citations in medical literature, the first testicle transplant was performed by Dr. Sherman Silber, in 1977, between identical twins. And it was successful as it turned out; as the recipient later fathered four children (his brother's technically). In fact, both the wire services and the medical literature were wrong, and their claims betray a collective amnesia over what has to be one of the most sensational and regrettable episodes in medical history.

The first testicle transplant was in fact performed on roosters by the German physiologist, Arnold Berthold, in 1848. Berthold castrated six male birds and noticed that the birds lost their plume, their aggressive tendencies and all interest in Henhouse magazine centerfolds. He then re-implanted the testicles in two of the birds and in two others, transplanted donor testicles from the last two birds. All four re-testiclized roosters regained their strut and resumed their roosterish ways. Although his experiment was ignored for half a century, Berthold is now held in high regard as the father of modern endocrinology.

The first recorded human transplant was performed in Philadelphia in 1911 by Drs. Levi Hammond and Howard Sutton. The recipient was a 19 year man who had been kicked in the balls. The donor was another young man who had recently bled to death (the alternative would have been a sheep, apparently). Not surprisingly, given the lack of knowledge of immune system functioning at the time, the organ was rejected and the episode was largely forgotten.

But the granddaddy of testicle transplants, the man who truly deserves primacy in this questionable field, was a Chicago urologist by the name of Victor Lespinasse. Lespinasse's operations and their reported success ignited a flurry of testicle transplants in the early 1920s in what has to be one of the weirdest episodes in medical history.

Lespinasse's first transplant patient was a 33 year old man who had the misfortune of losing both testicles independently. The first was lost in a botched hernia operation, the second after an accident. After the loss of the second testicle, the man found he was unable to perform sexually and sought Lespinasse's help in January of 1911. Operating under the assumption that the testicles were the source of masculine vigor, Lespinasse performed the first ever testicle transplant in 1911, three months earlier than the Hammond/Sutton procedure, but he didn't write about it until 1914 (it's "snooze, you lose" in the world of scientific accreditation).

Rather than transplant the donor testicle intact (it was believed to have been purchased from some poor sap who needed the dough), Lespinasse grafted testicle slices (theory being that thin slices would more likely fuse to the existing tissue and not be rejected) in the scrotum and rectus muscle. According to Lespinasse's reports, four days after the operation the recipient reported a strong erection and checked out of the hospital to put it to good use. After a follow-up two years later, Lespinasse reported that the man's virility remained intact.

While it's certainly possible that the Lespinasse's patient did indeed experience a testosterone surge in the days following the tissue implantation (remember Berthold's roosters), given what we know about the workings of the immune system, the effects were likely short-lived. If Lespinasse himself had reservations about the long term prospects of his procedure (he later wrote that it was impossible to separate the effects of the testicular grafts from the "strong mental stimulus engendered by the operation"), he nevertheless continued to perform and champion the procedure. In 1922, Lepinasse performed the surgery on Harry F. McCormick, one of the richest men in the world at the time and the subject of much tabloid gossip. Such was his fame that the procedure made the front page of the New York Times. The donor was reputed to be that exemplar of maleness, a blacksmith, inspiring the ditty:

Lespinasse's reported successes encouraged others to follow. An early enthusiast was Leo L. Stanley, the chief surgeon at San Quentin Prison who performed the operation on geriatric prisoners (volunteers, of course). Stanley theorized that tissue obtained from negroes would have a greater concentration of "virilizing essence" and preferred to use black men as donors. Luckily, he had an abundant supply: executed prisoners.

By the early 1920's, testicular transplantation was the impotence therapy of choice for men with soft dicks and hard cash. Much of this, it must be said, was driven by wishful thinking. People really wanted this to work, none more so that the patients themselves. After all, they had submitted to the procedure and likely paid handsomely for a donor to offer up a gonad. Nobody wanted to admit being a sap. As a result, the reported successes were numerous and failures few. Like stock market bubbles and magnetic therapy, testicle transplantation was an empty fad that fed off itself. People got caught up in the optimism as did the doctors who performed it. In 1920, Dr. G. Frank Lydston, a colleague of Lespinasse and one of the leading practitioners of testicle transplantation, had the procedure performed on himself. If nothing else, the success of testicle transplantation in the 1920's is a testament to the powers of the placebo affect.

At about the same time, across the Atlantic in Paris, a Russian surgeon named Serge Voronoff came up with a brand new testicular procedure. The technique was the same, essentially the one practiced by Lepinasse, the big difference was that the donors were chimps. This was partly out of convenience, partly because Voronoff thought it unethical to "remove the source of vigor from a young man for the sake of making an old man young." But mostly it was out of an unerring instinct for self-promotion. While there is no doubt that Voronoff fully believed in the rejuvenating powers of "monkey grafts", he will be remembered as one of the greatest hucksters in medical history.

Voronoff actually performed the operation with donor and recipient side by side, both stretched out on the table with their nuts hanging out. Needless to say, the recipient was the only one there out of choice. By all accounts it wasn't fun for the chimps, who had to be caged and gassed prior to the procedure.

This was shock-science and Voronoff's experiments received a great deal of attention internationally. At first, the scientific community was horrified by the thought of xenotransplantation. But when Voronoff screened films of the procedure, as well as before and after footage, to audiences around the world, he slowly won them over. In his films, men who were clearly in the advanced stages of decrepitude were shown months after the operation riding horseback, rowing and doing other manly athletic feats. The films didn't show any great strapping erections, but Voronoff made it clear that his operation rejuvenated the recipients sexually as well. In 1923, Voronoff was given a standing ovation by 700 doctors at the International Collage of Surgeons.

Voronoff's fame spread throughout Europe and North America, convincing Leo Stanley to give up on executed prisoners and move on to apes. Stanley went on to perform 300 testicle transplants using apes. Such was the popularity of the procedure that it inspired the pulp novel The Gland Stealers, and a cocktail drink called the Monkey Gland, which supposedly imparted some of the same rejuvenating effects. The French Government even had to pass a law banning monkey hunting in its African colonies.

What is perhaps most remarkable about this whole sorry episode is not that the procedure became widespread, but that it endured for so long. For a period of over 15 years, nobody seriously questioned the efficacy of the procedure. It all came to an end in 1929, however, when Henri Velu, a French veterinarian, conducted microscopic analysis of his own grafting experiments and found that the tissues had been completely rejected. He concluded that testicle grafts were "Une grande illusion." Other scientists confirmed Velu's conclusions and monkey grafts eventually fell out of favor.

Over the course of his career, Voronoff supposedly performed more than a 1,000 operations. And at fees of upwards of $5,000 a pop, he was certainly one of the richest doctors in the world. Yet he lived to be a tragic figure. He had genuinely believed in his procedure and was horrified at the thought that his grafts may have introduced simian diseases into their hosts. Voronoff, died broken-hearted in 1951; in the end, just a prurient footnote in medical history.

Penis enlargement surgery (also known as penile augmentation or penile enhancement surgery) consists of two surgical procedures to enlarge the penis, one is used to increase the girth of the penis, the second is used to increase the length of the penis. Typically, patients opt to have both penis enlargement procedures carried out at the same time.

Thanks to : Penis Pills

Dr Moore estimates he has performed over two-thousand penis enlargement operations since he first began using procedures to increase both the length and girth of the penis in 1967. Typically, such surgery was used to treat the condition known as micropenis, characterised in infants by abnormally small genitalia. He has performed genital reconstruction (penis enlargement) for the micropenis condition in Australia, the Middle East, the United Kingdom and the United States.

Dr Moore said the idea to patent the penis enlargement procedure came about over dinner with a friend who worked in the legal profession. "I was a little frustrated that other surgeons would observe the penis enlargement procedures I carried out and then copy them. I felt that I had invested so much time in perfecting these procedures that I wanted to protect them. A friend of mine, a lawyer, suggested the patent process as a way of protecting the penis enlargement procedures I had refined. From there, it took about a year or so for the patent to be granted."

Whilst various patents for cosmetic surgery procedures already exist, Dr Moore believes this is the first time that a patent has been granted for a penis enlargement procedure. Dr Moore is now looking to secure a medical licensing agreement so he can formalise training arrangements with other cosmetic surgeons and capitalize on the knowledge he has gained over many years. "With this sort of training, other surgeons will be able to quickly reach the skill level in penis enlargement it has taken me thirty years to obtain," said Moore.

Dr Moore said demand for penis enlargement was growing very rapidly. "Back in 1990, we would perform a handful of these operations in a year. Now, we are performing over two-hundred penis enlargement procedures a year. Originally it was just to treat the micropenis condition, but now, men with what would be called a normal sized penis want to get bigger."