April 2008


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June 12, 2000 — The gods of sex have blessed men with Viagra, but what good is it if their female partners have lost interest?

Traditionally, men’s sexual problems have gotten the lion’s share of attention, prompting remedies from Viagra to vacuum erection pumps to penile implants. The focus has been mainly on men despite the fact that women are more likely to have sexual troubles. A survey published in the February 10, 1999 issue of the Journal of the American Medical Association found that 43% of 1,749 women had complaints about sexual erectile dysfunction drugs
, compared with 31% of the 1,410 men surveyed. Subjects ranged in age from 18 to 59. The women reported low sexual desire, problems with arousal, and pain during erectile dysfunction drugs
. And these problems increase with age, experts say.

A Changing Picture

Why has research on women’s sexual comparison cost viagra
, as it’s medically known, lagged in the first place? It’s partly due to the difficulty of defining the problem. Even though impotence in men can be organic or emotional, the inability to obtain or maintain an erection is often the target for therapy. In women, sexual problems can get more complicated. They can include, for instance, a lack of desire, insufficient generic pharmacy viagra
, an inability to reach orgasm, or pain during intercourse. The causes can be physical, such as poor circulation, or emotional, such as stress or depression.

Finding remedies has also been a challenge because drugs that boost men’s sex lives may do nothing for women’s. A recent study of Viagra in women, released at the annual meeting of the American College of Obstetricians and Generic information viagra
, showed that it worked no better than a placebo in improving sexual response.

Lately, however, as researchers have discovered more about the types and causes of women’s sexual problems, the outlook is becoming brighter. New drugs are in development specifically for women’s sexual problems. And a new clitoral suction device, meant to enhance blood flow, has been approved by the FDA.

Though many of these remedies for women’s sexual problems are months or even years away from druggists’ shelves, there are still avenues to relief right now — if a woman doesn’t give up easily and finds the right doctor.

One Woman’s Story

Peggie is one of those women who don’t give up easily. She and her husband of 25 years had always enjoyed an active sex life. Then, at age 51, she started experiencing hot flashes and, along with them, something she never expected — a loss of sexual desire.

“No one told me that when you hit menopause, forget about sex,” she says. “It was a shock to me.” Other women confided that their libidos had plummeted, too, with menopause. They told Peggie, “That’s just the way it is when women age.”

But like other women who came of age during the sexual revolution, Peggie felt that women’s sexual pleasure is as important as men’s. So she went looking for help.

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June 25, 2001 — It probably won’t be coming soon to a bar or
urology clinic near you, but a cocktail of crushed termites, mashed ants, chili
peppers, and fruits packs a Citrate generic sildenafil viagra wallop and could be a natural
alternative to Pfizer’s little blue pill as a treatment for erectile
dysfunction, says a Cornell University plant biologist who personally vouches
for the natural compound.

On a trip to Venezuela, Eloy Rodriguez, PhD, was given some of
the substance by his hosts to use as a spice for his food. “After I took a
lot of it they looked at me with total surprise and said, ‘You’re going to need
a doctor in the morning, because it’s going to make your penis get very hard,’
and they were absolutely correct. It was very powerful,” says
Rodriguez.

You don’t need a prescription for the “bio-Viagra,” but
you do have to travel to the Amazon region of Venezuela and ask the women of
the Yequana tribe to mix up a batch of it, he says.

“Every tribe in the Amazon has a substance, extract, or
mixture that they will is there a female viagra where it available
tell you is used to stimulate erection. If
you go to the Caribbean you’ll find the same thing. It’s been there since the
beginning of time. I think that in earlier times, stimulants must have been
very important, because being the king or the ruler in power you had to be
sexually quite potent and be able to maintain it.”

Back in their lab in the Finger Lakes region of New York,
Rodriguez and colleagues performed a chemical analysis on the drug for treatment of erectile dysfunction
potion
and found that it contains chemicals similar to those found in Viagra, as well
as a healthy dose of treat erectile dysfunction the best, both of which might account for the
compound’s impressive action. The researchers are currently exploring plant
derivatives from the Caribbean island of Dominica and from the Dominican
Republic that are said to have similar properties to the Yequana mixture.

“I think as one does more serious chemical research, we’re
going to uncover ‘natural’ Viagras that might even be more potent than the one
that has been made synthetically,” Rodriguez says.

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Erectile Dysfunction Drugs27 Apr 2008 07:30 pm

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April 10, 2000 (Mill Valley, Calif.) — In his early 40s, Ron Hanson was too
young to be having trouble getting and sustaining erections. But like many men,
he was too embarrassed at first to talk about the problem. Hanson (not his real
name) waited seven years to see a urologist. By the time he spoke up, erectile
dysfunction had become a household word, thanks to the popularity of the drug
Viagra. But the widely touted drug, Hanson soon learned, doesn’t work for
everyone.

When Viagra (sildenafil) hit the market in 1998, some men thought it was the
long-awaited answer to their problems. Many rushed to doctor’s offices to give
it a try. According to the Grey Clinic in Ed medicine
, which specializes in
erectile dysfunction, 17% of men between 18 and 55 experience occasional
impotence, while 6% have regular erectile difficulties. For men over 55, that
number jumps to about one in three. Some common causes of impotence are
diabetes, heart disease, and psychological problems. It also frequently occurs
after prostate cancer surgery.

Because Viagra works in a way that’s similar to drugs that contain nitrates,
however, it isn’t recommended for men who take nitrates for heart disease or
those with certain other heart conditions. In some men, it causes bad
headaches. In others, it just plain doesn’t work. In some instances, men may
notice they have trouble telling blue and green colors apart when they start
taking the drug.

During an erection, blood flows quickly into the penis, which increases its
length, width, and firmness. If the “in” vessels (arteries) are too
narrow or if blood drains too quickly through the “out” vessels
(veins), men may have trouble achieving or maintaining an erection, says Arnold
Aigen, MD, a urologist with Camino Medical Group in Sunnyvale, Calif. Viagra,
which increases inflow, may not be strong enough to work its magic if the
arteries are too narrow.

Hanson tried Viagra, but he couldn’t tolerate the headaches it caused.
Luckily, when Viagra fails, he discovered, there are several alternatives.

Alprostadil to the Rescue

A drug called Alprostadil, either alone or sometimes in conjunction with
others such as papaverine and/or phentolamine, can be injected directly into
the penis to dilate the arteries, experts say. The drug produces an erection in
about 10 minutes that can last up to an hour. But there are several
disadvantages, says Teresa Beam, MD, a urologist with the Grey Clinic. Some
patients are averse to using a needle, which is why many men abandon the
therapy. Those who give it a try may experience pain at the injection site or
priapism (a painful erection lasting too long).

As an alternative, Alprostadil is available as a pellet-like suppository
that is inserted into the tip of the penis and absorbed through the lining of
the urethra. This can help produce erections lasting for 30 to 60 minutes,
according to the Impotence World Association (IWA). Unfortunately, the
erectile dysfunction meds
are less effective than injections and may cause pain and
irritation, according to both Aigen and Beam.

Last November, a topical gel formulation of alprostadil was approved by the
U.S. Food and Drug Administration. It is too soon to know if this form of
alprostadil therapy will become widely used.

Mechanical Help

With a vacuum constriction device, the penis is placed in a cylinder with an
attached pump, creating a vacuum to draw blood into the penis. Firmness is
sustained by a constriction band placed around the base of the penis. The IWA
estimates the technique can produce erections for up to 30 minutes. Beam calls
the alternative “a good way to go” because it has minimal side effects,
but admits it is cumbersome and takes some practice.

Some men opt for penile implants, which involve the placement of tubes in
the penis and a pump in the scrotal sac. The pump (usually the size and shape
of a testicle) enables men to obtain an erection whenever and for as long as
they desire by pumping a saline solution from a reservoir into the penis.
Implants are a last resort, however, says Beam. “Once a prosthesis is
implanted, a patient cannot respond to anything else because it alters the
natural anatomy.”

Fortunately, Ron Hansen didn’t have to go that far. He has become used to
injecting himself with Alprostadil, which produces a firmer erection than he
experienced with Viagra, and one that lasts at least 30 minutes. It also
doesn’t cause the headaches associated with Viagra. Hanson erectile dysfunction pill
uses
the suppositories, though they take longer to work.

For Hanson, admitting that he had a problem in the first place was the
hardest part. “But when you don’t function as you should,” he says,
“the therapy makes a big difference.”

Mari Edlin is a freelance journalist and marketing
communications consultant specializing in health care. She contributes
regularly to Healthplan magazine, Modern Physician, and
Managed Healthcare magazine, and works with many health care
dysfunction pill
in the San Francisco Bay Area.

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Erectile Dysfunction27 Apr 2008 01:39 pm

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A night at the Bridge Suite at the Atlantis Hotel will only set you back $25,000 (13,700) a night.

Feeling decadent, you could fill up your bathtub with Chanel No. 5 for $1.6m (800,000).

But if you want a 30-second advert during the Super Bowl, the championship of American football, it will cost almost $2.3m (1.3m).

With declining television audiences in the US, the Super Bowl is one event that can guarantee advertisers the most eyeballs for their buck.

A media event

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has risen dramatically in the last 38 years. In the first Super Bowl in 1967, a spot cost almost $240,000 in today’s dollars.

But there are few television events like the Super Bowl that can guarantee an audience of 140m viewers, especially with a declining network TV audience due to the Internet, DVDs and hundreds of cable, satellite and pay-per-view channels.

Apple computer

Apple has teamed up with Pepsi and former legal targets

“This is a throwback to old TV, when you didn’t have a choice. You couldn’t zap away from the commercials,” said Matt McAllister, an advertising and culture expert at Virginia Tech University.

“The Super Bowl is not just potential exposure to those eyeballs. It is exposure to those eyeballs. The idea that people channel surf at Super Bowl parties is absurd.”

And over the years, the ads have become an event unto themselves.

“The Super Bowl is something where the ads are covered as news themselves,” said Mr McAlister.

They are the only event in the TV year where the ads are previewed, and then critiqued on the morning news shows after the Super Bowl.

“Even the flop ads get free air time,” Mr McAlister said.

Cultural icons

The tone of the ads over the last few years have been more sombre following the attacks of 11 September and the lead up to war in Iraq.

But, back this year is the impotence research
tone that has made many of the ads cultural icons.

This year, Pepsi and Apple Computer will be poking fun at online music file traders.

Pepsi will be giving away 100 million from Apple’s iTunes music store, and the commercial features 16 teens who were sued by the recording industry for illegally impotence therapy
music.

The ad is set to punk band Green Day singing, “I fought the law (and the law won).”

An ad for office supply store Staples features a worker who rebels against an office supply clerk who demands pastries in exchange for folders and paperclips.

Instead of going through the supply clerk, he buys his supplies at Staples and with the help of some mobster muscle demands a pastry in return.

Politics-free zone

But in addition to humour this year, election year politics has tried to invade this perfect advertising environment.

President George Bush

Networks banned ads that poked fun at the president

The CBS network rejected ads from political activist group Moveon.org and from People for the Ethical Treatment of Animals (Peta).

The Moveon.org ad criticised President Bush for the ballooning national deficit, and the Peta ad promotes vegetarianism with the message that eating meat can cause impotence.

CBS rejected both ads on the basis of its policy against advocacy advertising, saying the policy was designed to prevent those who can afford advertising from having an undue influence on “impotence treatment
issues of public importance.”

Washington Post media critic Howard Kurtz said in an online discussion that the networks’ prohibition against advocacy advertising applies to everyone.

“When some group gets its ad rejected by ABC, CBS or NBC, it cries foul and political bias and censorship. But everyone in the issues realm is basically shut out,” he said.

But Peta spokeswoman Lisa Lange said: “CBS not only takes advocacy ads, but has shown them during the Super Bowl, including Truth.com anti-smoking ads and anti-drunk driving ads sponsored by beer companies.”

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Erectile Dysfunction Drugs26 Apr 2008 07:20 pm

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Six years after Viagra generic cialis tadalafil
sexual ability for men,
many women are still hoping for their turn. To date, the FDA hasn’t approved a
product to boost female sex drive.

It’s no small problem. A low sex drive is the most common
sexual complaint made by women — up to 30% to 40% of them, according to Sandra
Lieblum, PhD, director for the Center for Sexual and Relationship Health at the
Robert Wood Johnson Medical School in New Jersey.

The Search for a Cure

Throughout the ages, various potions and contraptions have
pledged relief, but the discerning have wondered if the so-called remedies are
truly love liniments, or merely snake oil.

Just because someone makes a claim about boosting female
libido, it doesn’t mean that it’s true, says Beverly Whipple, PhD, RN, FAAN,
vice president of the World Association for Sexology. “We have to make sure
that the claim is being made on scientific evidence.”

Yet, even if something appears to work in scientific research,
there is the concern that just being part of a study to improve a women’s sex
drive might itself have a suggestive effect on libido; it’s called a placebo
effect.

“It has to do with women’s expectancies and hope that any
intervention will prove beneficial,” says Lieblum, noting that impotence solution
can also change behavior. “Any woman who goes into a trial to improve
libido is motivated to be more active.”

The power of placebo is so strong that many health experts look
only to womens viagra
, placebo-controlled trials to prove a product’s
effectiveness. In these studies, a group of subjects receive a real drug, while
another set gets a dummy substance. Neither the researchers nor the
female uk viagra know which the real medicine is.

Apply this criterion to the dozens of buy online prescription viagra
for women
out there, and the number of suitable elixirs dwindles down to possibly one or
two that work for some women. Even with the best of studies, expert opinion
varies on what works best for female libido.

There is a consensus, however, on just how intricate female
desire is. “Women’s drive is so complex that biology is only one factor
that drives sex drive,” says Jean Koehler, PhD, a licensed family and
marriage therapist in Louisville, Ky., and past president of the American
Association of Sex Educators, Counselors, and Therapists.

Besides biology, the following factors can affect female
libido:

  • Quality of the relationship
  • Attitudes of upbringing
  • Support of peer group
  • Quality of touch and sex
  • Understanding of partners
  • Age
  • Illness
  • Use of medications
  • Emotional well-being

Trouble with one or a combination of these factors can affect
women’s sex drive. Such loss of interest in sex is medically identified as
hypoactive sexual desire disorder (HSDD).

There are some popular products that have either been designed
or tested to treat HSDD.

Viagra

Despite rumors and various advertising claims to the contrary,
there isn’t a female Viagra out there.

“We know that Viagra doesn’t work in women,” says
Whipple.

“Women are not minimen,” Whipple explains. “We are
different than men in what we want, what we desire, what feels good to us, and
we’re also different at the biochemical level.”

Female sexuality is, indeed, so much more complex than male
sexuality that even after several scientific studies involving about 3,000
women, Viagra-maker Pfizer hasn’t been able to come up with conclusive
findings. Earlier this year, the company announced it was ending research of
Viagra in women.

But this does not mean there isn’t hope for some women.
Research is ongoing on several other products for female libido.

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July 20, 2001 (Washington) — It’s called trail mix, and it’s a far cry from the healthy blend of fruits and nuts you’d take on a hike, say the experts.

Instead, it’s the latest party drug craze, consisting of ecstasy — known to cause an intense high — and Viagra, which is used to improve sexual prowess. For now, the primary users are gay men in New York City and Boston where trail mix is showing up at dance parties and clubs.

“It’s not necessarily sexual; if people want it to be sexual, they’ll put the stimulant methamphetamine in it. It’s just considered a more interesting version of ecstasy,” Patricia Case, ScD, of the department of social medicine at Harvard Medical School, tells WebMD.

Nor is trail mix limited to gay users; Case says many heterosexual men and teens are trying it as well. There are many popular variants of the drug combination, which is ground up into a powder and snorted. Ketamine, a cat tranquilizer, can sometimes be added to offer a mellower, longer high, but at a price.

“The down side is that the stimulant effect of the ecstasy can override the perception of ketamine, so that people can take too much … of the trail mix. And the ketamine then puts them into what’s called a ‘K-hole,’ which is a very unattractive state,” says Case.

As part of her studies, Case says she sees people unable to walk after taking the blend and some ultimately require medical attention. She describes their appearance as “glassy-eyed.”

Case presented her findings at the first generic sales viagra
conference on ecstasy under way this week at the National Institutes of Health. Some 600 researchers attended the event sponsored by the National Institute on Drug Abuse, or NIDA.

Ecstasy is one street name for MDMA, a laboratory drug has that has both the power to stimulate the brain and cause a hallucinogenic-like state. Since the mid-’90s when ecstasy first appeared in the rave club scene, it’s become an increasing public health threat, according to NIDA’s director, Alan Leshner, PhD.

Though illicit drug use was generally down among youth last year, that wasn’t true for ecstasy. “The demand is very great, and it has moved out of the club scene,” Leshner tells WebMD. “Now what’s so alarming is that this year, for the first time, we saw this increase in twelfth graders, tenth graders, and eighth graders,” he says.

For example, 3.1% of U.S. eighth graders have tried ecstasy, says Leshner, and 8.2% of twelfth graders have used the illicit drug. Overall, it’s estimated that more than 100,000 13- and 14-year-olds have taken the drug.

While the high can be intense, so can be the drug dysfunction erectile
, including possible brain damage or death. Ecstasy acts on two crucial brain chemicals: dopamine, which is linked to stimulation and serotonin, a mood modifier.

Animal studies have already shown that ecstasy destroys serotonin-producing cells. “Think about going around for weeks with your brain impaired … at least,” says Leshner.

Ecstasy can also cause a fever as high as 108 degrees.

Although one doesn’t acquire a physical dependence on the drug, Leshner says people develop a compulsion to get it. And that’s not just in the big cities. Robert Carlson, PhD has done a preliminary study on ecstasy use in Ohio.

Carlson tells WebMD his state is the “heart of it all.”

“It’s far more pervasive in our high schools, at least in our part of the country, among high school aged youth and young adults,” says Carlson, a medical sildenafil citrate viagra at the Wright State University school of Medicine in Dayton, Ohio. He got his information from a broad group including active users, police, and treatment providers.

One of the big issues, says Carlson, is that kids still haven’t heard their peers talk about overdosing on ecstasy or getting arrested. So while there’s still time, he cautions parents to discuss the issue with their children.

“You have to converse with them and just say, ‘Do you come in contact with it?’ … Then tell me about it,” says Carlson.

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Nov. 14, 2001 — Viagra has helped thousands of impotent men restore their sex lives. But for men with chronic heart failure and impotence, the “little blue pill” may not be an option. Many of these men take nitrates for heart failure, which can prove deadly if combined with Viagra. But there may be an alternative. Researchers have found that a regimen of regular bike riding can improve overall health, as well as sexual function, in men with chronic heart failure.

“We found that exercise can act as a medical therapy to improve both sexual function and overall quality of life in these patients,” says study leader Romualdo Belardinelli, MD, director of the Lancisi Heart Institute in Ancona, Italy, in a news release.

Belardinelli team looked at about 60 men, average age 57, with stable, chronic heart failure but no prostate problems. About half of them were taking nitrates. The ed pills
randomly split the men into two groups. One followed an eight-week regimen of supervised stationary bicycling three times per week; the other maintained their normal lifestyles. All the men continued on whatever drugs they’d been taking. They completed online sildenafil citrate on quality of life and sexual activity and underwent fitness and overall health testing before and after the study.

At the end of the study, tests revealed generic viagra and drugs
s in the cardiovascular systems and overall health of the exercise group but not the control group. Peak oxygen uptake had improved 18%, and blood vessels were responding more appropriately. What’s more, these objective dysfunction pills
correlated with self-reported improvements in quality of life and sexual function.

“We found significant improvement … among patients who were cycling,” says Belardinelli. He suggests that the exercise may boost health by causing positive changes in the cells (called the endothelium) that line the blood vessel walls. These changes would mean more oxygen-rich blood is reaching all parts of the body, including the penis.

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Erectile Dysfunction Drugs23 Apr 2008 06:50 pm

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Aug. 9, 2001 — Mention Viagra, the popular drug used to treat erectile dysfunction, and people tend to snicker. But as researchers at Boston Children’s Hospital and other centers have found, Viagra could be a life-saver for kids with a rare but cialis vs viagra
fatal lung disease called pulmonary hypertension.

According to the National Heart, Lung, and Blood Institute, about 300 cases of pulmonary hypertension are diagnosed in the U.S. each year. In the disease, blood pressure within a certain vessel in the lungs rises sharply for no known reason. The increase in blood pressure, or hypertension, leads to stiffening of the blood vessels in the lungs. This causes increasing shortness of breath and puts a severe, often fatal, strain on the heart.

Children with the disease are typically treated with nitric oxide delivered through a erectile dysfunction remedy
; the gas helps the blood vessels in the lungs relax and allows more blood to flow through them. Yet when doctors try to wean them off the gas, their blood pressure can skyrocket again, putting them back in danger.

But as David Wessel, MD, and Andrew Atz, MD, reported in the journal Anesthesiology in 1999, the same mechanism that helps men with erectile dysfunction achieve erection after taking Viagra may also help children be eased off nitric oxide. The drug works by preventing the release of nitric oxide from blood vessels, allowing the vessels to stay relaxed and blood to flow through them.

Marshall L. Summar, MD, who commented on the Viagra treatment, tells WebMD that a child’s inability to produce enough nitric oxide appears to be a factor in them developing the disease.

“Anything you can do to bolster nitric oxide production is probably going to be of some help,” he says. “There are probably some more direct ways to get at it that are a lot cheaper than Viagra that we’re looking at, but that’s for the future.” Summar is associate professor of pediatrics in the division of medical genetics and molecular physiology and biophysics at Vanderbilt University Medical Center in Nashville.

To date, Wessel and colleagues at Children’s Hospital have successfully weaned 13 of 14 children off of nitric oxide, in some cases using Viagra pills they crushed and delivered through feeding tubes. An additional 15 to 20 children have been treated at other hospitals with similar results, Wessel said in a Boston Globe interview last week.

Wessel recently returned from London, where he and nine other doctors attempted to persuade Pfizer, the maker’s of Viagra, to develop and test the drug in an intravenous soft viagra
that would specifically treat children with pulmonary hypertension.

But because the demand for drugs to treat this disease is very small compared to the erectile dysfunction meds
dollar market for erectile dysfunction drugs, it’s not certain whether Pfizer would be willing to commit to the estimated $4-10 million it would cost to test a reformulated drug in clinical trials.

“Our focus right now is on the medical dysfunction pills
,” Pfizer spokesman Geoff Cook tells WebMD. “There has been data out there that seems to show Viagra potentially could be a very important treatment for a condition that really has no treatments. It’s a crying medical need and that’s our focus.”

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Sept. 26, 2002 — That little pill that has helped millions of men reclaim their sex lives may also work for some women.

Women with arousal problems who took Viagra in a study funded by the drug’s manufacturer achieved sexual cialis vs viagra
more often than those who took placebo pills. But further research is needed to prove that the impotence pill has a role in the treatment of female sexual dysfunction, experts say.

Viagra works in men with erectile dysfunction by increasing blood flow to the penis. It is not clear whether viagra soft blood flow plays a role in some female sexual problems, but researchers say the results of this study suggest that it does. The findings were presented this week at the 10th World Congress of the International Society for Sexual and Impotence Research in Montreal.

Roughly 42% of the women taking Viagra reported increased satisfaction during foreplay and sexual intercourse, compared with 28% of women taking the placebo. Likewise, 57% of the Viagra-treated women reported improved sensation in the genital area during sex, compared with 44% of women taking the placebo. Side effects of treatment with Viagra were considered mild to moderate and included headaches, flushing, runny nose, and nausea.

Viagra seemed to work best in women with sexual arousal problems who had previously satisfying sex lives. It was less effective in those who had both arousal problems and problems with sexual desire.

“Viagra doesn’t really increase desire in men, so there is little reason to believe it would do so in women,” says sexual dysfunction exert Marian Dunn, PhD. “This study shows that a subgroup of women might benefit from Viagra. A woman with normal hormone levels who is in a good relationship and used to enjoy sex but no longer does might be a good candidate.”

Dunn, who is director of the Center for Human Sexuality at SUNY Downstate Medical Center in New York, tells WebMD that female sexual dysfunction is only now beginning to get the attention it deserves.

“We don’t really have much to offer women,” she says. “I’m a sex therapist, and I know that many women are helped by therapy, but many others either don’t have access or would not be open to it. There are a lot of women out there who are suffering, and many might find this treatment to be effective.”

But psychologist Leonore Tiefer says sexual problems tend to be more complex in women than in men and probably will not be as easy to treat with drugs. An outspoken critic of drug industry-sponsored research into female sexual dysfunction, Tiefer warns of what she calls the erectile dysfunction drugs
of sex problems in women.

“In the study, 44% of the women taking placebos had improved genital sensation,” she says. “That sounds high, but it is standard for the placebo arm of Viagra studies. Once you take a pill, no matter what it is, you make love in a different way and there may be a benefit. The problem is that you shouldn’t take medicine unless you need it, and this drug has side effects.”

Viagra is not approved in the U.S. for use in women. A viagra vs cialis
for manufacturer Pfizer Inc. tells WebMD that the decision about whether to seek such approval will be made when larger clinical studies are completed. –>

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Much of the real contest happens well in advance of polling day, in this instance 20 February for election to the seventh Majlis (parliament) since the Islamic Republic was established in 1979. Actual campaigning only lasts a week, and probably has little actual impact on the eventual outcome.

This election is no exception. Nearly six weeks before the ballot, a fierce battle erupted after it became clear that vetting committees under the unelected and highly conservative Council of Guardians (GC) had disqualified more than 3,500 of the 8,000 or so would-be candidates nationwide, the majority of them believed to be reformists.

The speaker of the outgoing, reformist-dominated Majlis, Mehdi Karroubi - a moderate reformist whose election credentials were approved - accused the GC’s vetting committees of planning the impotence helps how to overcome impotence in order to ensure a conservative victory.

Some hardliners have made it clear they would like to see the reformists, whom they regard as little more than traitors pandering to the West, eliminated from political life.

Threats, bluffs and bargaining

The mass erectile dysfunction drug
issued by the GC on 10 January represented the opening bid by the smoking and impotence in a campaign of pressures, threats, bluffs and hard bargaining that is now under way.

Iran's Supreme leader, Ayatollah Ali Khamenei

Mr Khamenei alone has the authority to resolve a deadlock

It was a high bid indeed. At this stage in the 2000 general election, 758 would-be candidates were disqualified out of 6,860 who registered nationwide. While the registrations this time are somewhat higher, the number of disqualifications is nearly five times as many.

On Friday, the council reinstated a third of the candidates, but this falls far short of the full reinstatement demanded by reformist MPs, 80 of whom are themselves on the blacklist.

The reformists are obliged to make as much noise as they possibly can, to try to maximise the pressure they can exert, through leaders such as President Khatami and Mr Karroubi, on Supreme Leader Ayatollah Ali Khamenei and the GC itself.

Arbiter’s role

It is Mr Khamenei who will act as the fulcrum around which the balance settles. He alone has the authority to intervene in case of deadlock or a danger of tensions exploding out of hand.

His influence with the GC cannot be gainsaid - of its 12 members, he appoints six outright, and the other six (although endorsed by parliament) are appointed by the head of the judiciary, himself a Khamenei appointee.



The outcome of the poll is by no means certain - the Iranian electorate has in the past produced many surprises, not least the landslide election of Mr Khatami himself in 1997


Ayatollah Khamenei is not a power figure with an independent base in his own right. His authority is drawn from his position, but in reality he is an arbiter trying to balance conflicting pressures and use his influence to persuade or dissuade.

While the reformist side can try to maximise pressure, the decision is ultimately in the hands of the right wing, which holds much of the real power.

The question is whether it really intends to go for broke and cripple the reformists in advance of the polls, or whether the pragmatic, moderate conservatives can persuade the leader and the GC that a compromise must be sought.

Thrown into the balance on the side of moderation will be the argument that the wholesale elimination of reformist candidates could force those who want change to move outside legal frameworks, with potentially violent consequences.

A one-sided field would also be highly likely to produce an extremely low voter turnout, raising an immediate question of legitimacy for a minority right-wing government.

That in turn would be expected to put the regime under increased international pressure and isolation. Both the US and the European Union have already expressed concern over the high level of disqualifications.

Pragmatic trend

If the GC stands rigid, it could well leave President Khatami and his reformist administration with no choice but to resign, with further consequences for Iran’s international position.

Iran's Parliament Speaking Mehdi Karoubi (centre) tries to calm the protests

Reformists like Mehdi Karroubi (2nd left) may gain from sympathy votes

Mr Khatami has promised to stay true to his pledge to safeguard the rights of the people to elect and be elected. He has dissuaded top officials from resigning now, and tried to call off the MPs’ sit-in, on assurances that the GC would exercise moderation.

If those assurances prove misplaced, he would feel doubly obliged to stand down.

Some hardliners - who believe ultimately that authority comes from God through the leader, and not from the people - would undoubtedly be prepared to shrug aside such concerns.

But the recent trend in Iranian politics has favoured the pragmatic conservative moderates. The crisis late last year over the country’s nuclear programme was resolved - at least temporarily - with their support and that of the leader for compliance with the International Atomic Energy Agency, and the real hardliners were obliged to stifle their strident objections.

If that trend prevails, a reasonable number of reformist candidates would be re-qualified and allowed to run.

Reformist leaders have said that in such a situation, they would expect to win at least half the seats.

Sympathy vote

Even before the current crisis, the reformists’ electoral prospects were not looking bright. Many reformist officials feared a repeat of last February’s local council elections, which saw widespread popular disillusion reflected in a massive abstention - voter turnout in Tehran itself was around 12%.

As the conservatives can always count on a bedrock vote of regime loyalists, they regained Tehran city council and others.

The mass disqualification could win a sympathy vote for surviving reformist candidates - though it also underlines the impotence that has been forced on them by right-wing fixing erectile dysfunction
during their years in office.

Looking for silver linings in a decidedly black cloud, some reformist leaders said that if the current situation produces a parliament heavily influenced by pragmatic conservatives, it would be a major reformist achievement as it would take power away from the real hard-liners.

The outcome of the poll is by no means certain even once the list of candidates is finalised. The Iranian electorate has in the past produced many surprises, not least the landslide election of Mr Khatami himself in 1997.

All recent national votes have shown at least a solid 70% favour reform and that is unlikely to change. The huge and unpredictable variable is how many will bother to vote. Many people have said they would not - but a late swing back, as happened in Mr Khatami’s second election in 2001, can by no means be excluded.

And some information of erectile disfunction.

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