Try to look at it this way. Imagine that you are someone who is afraid of public speaking. You get extremely anxious and tense before you have to talk in front of a group of people. You’re afraid your speech will fall flat, your audience will be bored, or someone will ask you a question you have no idea how to answer. You feel your throat closing up as your nervousness increases. All the witticisms you so carefully rehearsed, the jokes and anecdotes you collected for this occasion, desert you in your moment of need. This is performance anxiety. It’s the same thing that sometimes hits a man when he gets in bed with a lover. He worries that he won’t get or maintain a good erection and that his partner will be disappointed. Maybe he’s been rehearsing the encounter over and over in his head, and feels like he’s about to go onstage.

There are professionals who can teach you to relax and be a better, more confident public speaker. Well, a sex therapist can offer the same kind of help for some men with erection problems. Specifically, sex therapy can help men whose erection problems are caused by anxiety, nervousness or other psychological distress; and men whose erection problems have a physical cause or a physical contributing factor, but who want to learn how to increase their sexual pleasure and possibly improve their erections, as much as possible. Sex therapy can teach you how to pleasure yourself and your partner; how to enjoy other types of sexual contact besides intercourse; and how to communicate better with your partner.

Can sex therapy help you? The best answer to that question comes from some self-evaluation and from an assessment by a trained, experienced sex therapist. In general, however, there are certain characteristics which make someone more likely to benefit from sex therapy, and more able to learn solutions to correct an erection problem.

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Acupuncture is performed in every state in this country. An estimated three thousand medical doctors and osteopaths have studied and used acupuncture in their practices. Approximately seven thousand nonphysician practitioners currently use the technique to help control pain and treat addictions, depression, insomnia, and other health problems. You should be aware of the licensing regulations in your state. To find a physician/acupuncturist in your region, contact the American College of Acupuncture at 212-876-9781.

Note: Before trying acupuncture to treat ED or any condition, consult with your doctor. As is the case with other forms of alternative medicine, acupuncture should be used only as an adjunct to regular medical treatment—never as a substitute for it.

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ED medication is also effective for men on cholesterol-lowering drugs. When Michael, fifty-seven, came back to my office after his ultra-fast CT test, the special five-minute heart exam confirmed the presence of plaque in his coronary arteries. This was not surprising; he had a family history of heart disease coupled with his own high cholesterol levels.

I prescribed Lopid (gemfibrozil) to lower his cholesterol and triglyceride (fatlike substances) levels in his blood and reduce the risk of a heart attack. Lopid seems to work by raising the level of high-density lipoprotein (HDL) cholesterol, which counteracts the effects of the low-density lipoprotein (LDL) cholesterol, the type that increases the chance of having a heart attack. I informed Michael that the drug would probably work well for him—but that it might also cause erection problems. Knowing the danger he was in, Michael agreed to start medication at once.

At his next visit, I was satisfied to see that his cholesterol levels had dropped to an acceptable level—210 mg—and that his triglycerides had plummeted as well. But Michael’s reaction to the good news was one of indifference. “Sure, the results are great,” he sighed. “But 1 can’t have sex—so, I still don’t feel so good.”

I explained that now that his life-threatening condition was under control, we could address the medication’s side effect. As part of the Vasomax trials, he tried the pill.

A month later, Michael’s wife, Louise, called me. “I just want to tell you myself how grateful we are. Knowing that Michael is healthy is such a relief. Knowing that we can be together the way we want is a gift.”

For those men battling depression with medication, there is hope as well. For Richard, a thirty-five-year-old lifelong depressive, taking Prozac was, in his words, “like watching a dark curtain lift and seeing the sun again.” With his life and outlook much improved, he began dating and was several months into a loving relationship when he came to see me. “I’m perplexed,” he began. “Sometimes I can’t get an erection and other times I’m really hard—but I don’t come.”

Under treatment with a therapist, Richard rejected the idea of switching to another SSRI medication to see if his erection problems would disappear. He felt that the mental stability he had achieved with Prozac was too precious to jeopardize. Instead, he wanted to know if the erection pills could work for him.

I informed Richard that information on the ability of Vasomax to overcome the sexual-inhibiting effects of the SSRIs was limited. So far, few of the men participating in the trials were on antidepressants. The same was true with the Viagra studies. I went on to say, however, that the anecdotal evidence I had seen with Vasomax was positive and worth pursuing. In Richard’s case, the results he achieved with Vasomax were consistent with that of other patients: the SSRIs did not hamper the workings of the pills, and his erectile problems disappeared.

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What would happen if Viagra and Vasomax were given simultaneously? We know that each drug influences a different chemical messenger system in the body. So, in theory, once they were teamed up they could then develop greater effectiveness, possibly diminishing each other’s side effects while enhancing erection capability.

Already, expert urologists are enticed by the idea because there are ample comparisons. Often, in the treatment of hypertension and certain cancers, physicians prescribe chemical “cocktails.” In doing so, they combine two or more drugs in such a way that any potentially negative aspects of the stronger drugs may be offset by the positive effects of the milder ones. The end result could be an even more potent treatment that works much more effectively.

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It’s important to take time out for sex. Sex therapists tell people to allocate one hour per day to sensually caressing, massaging and relating to one’s partner. But you don’t have to pay a therapist to benefit from this advice and to reap the pleasurable results.

Sensual Pleasures

William has problems making love with his wife because he focuses on making his penis do what he wants rather than enjoying being close to Sharon. Forced erection is a false notion. Although he caresses and cuddles her, he doesn’t concentrate on her touch, the smell of her hair, the taste of her lips and the sight of her body. Instead, he is preoccupied with whether his penis will “work.” That’s like eating dinner and being involved with the knife and fork, rather than the gourmet feast before you. What a waste.

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Several effective topical applications are available including:

benzyl benzoate application 25%; and

lindane (gamma benzene hexachloride) 1 % cream or lotion.

An effective regimen is lindane lotion applied to the affected region overnight and washed off. Repeat in 24 hours. It may be necessary to repeat in 7 days if eggs hatch. When treatment is commenced, clean sheets, underclothing and nightwear should be used; bed linen and clothing should be washed in the hot cycle of a washing machine and dried completely in the sun or a hot drier. Lindane should not be used during pregnancy or lactation. If there is secondary infection, systemic antibiotics may be necessary.

Sexual contacts of the infested person should be treated at the same time. The family and other close contacts should be examined and treated if they show evidence of infestation.

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Defined as encephalopathy which can be progressive and may cause dementia, aseptic meningitis, myelopathy or peripheral or autonomic neuropathy.

Subgroup С

Denned as the presence of a disease at least moderately indicative of a defect in cell mediated immunity. These are divided in subgroups:

C-l: Patients with disease due to one of the organisms listed in the surveillance definition of AIDS viz Pneumocystis carinii pneumonia, chronic cryptosporidiosis, toxoplasmosis, extraintestinal strongyloidiasis, isosporiasis, candidiasis (oesophageal, bronchial or pulmonary), cryptococcosis, histoplasmosis, Mycobacterium avium-intracellulare (MAI) complex or M kansasii, cytomegalovirus (CMV), chronic mucocutaneous or disseminated HSV infection, progressive multifocal leukoencephalopathy, recurrent salmonella bacteraemia or extrapulmonary tuberculosis.

C-2: Secondary infectious agents not listed above but involving symptomatic or invasive disease e.g. oral candidiasis, oral hairy leukoplakia, multidermatomal herpes zoster, nocardiosis or pulmonary tuberculosis.

Subgroup D—Secondary cancers

Denned as the presence of a cancer associated with HIV infection including Kaposi’s sarcoma and extranodal B-cell lymphoma.

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The patient should be told the diagnosis, the natural history of syphilis and the need for compliance with treatment and for regular follow up with clinical examination and repeat serological tests.

The cooperation of the patient in the following up of known contacts should be sought at an early stage.

Notification of cases of syphilis is required in all States and Territories although the name and address of a patient is not required unless the patient defaults.

The patient should avoid sexual intercourse until all lesions have healed and until the antibiotic course is complete.

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B-lactamase (penicillinase) producing N gonorrhoeae (PPNG) is resistant to penicillin and is common in South East Asia and endemic in Australia. Spectinomycin and cephalosporins are effective in treating these infections. Spectinomycin-resistant PPNG strains have been reported but are not yet a problem. A high incidence of PPNG indicates poor STD control. Although the total number of cases of gonorrhoea in Australia has been falling for several years, the proportion of cases with PPNG infection is increasing.

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What recent sexual contacts including regular partners, casual partners, prostitutes etc. has the patient had?

Has the patient ever had homosexual contacts?

If contacts have included homosexual encounters, what form did the encounters take?

Did a partner have STD or was a partner in a risk group for STD (illicit drug user, prostitute, bisexual man etc.)?

Have there been sexual contacts in overseas countries (e.g. South East Asia, other tropical or third world countries or the United States)?

If oral or anal sex was involved, did the patient take an insertive or receptive role?

Have condoms and other appliances or apparatus been used?

Information about contacts is sought to identify the source contact and to identify people to whom the infection may have been spread. Patients are often incorrect in attributing the source of infection. Remember to enquire specifically about sexual contact with the spouse or regular partner subsequent to infectioa

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