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2 The available treatments include vacuum-constriction devices; intracavernosal injections dating service teen of vasoactive agents, dating service teen including alprostadil (prostaglandin E 1 ) 4 ; transurethral delivery of alprostadil 5 ; implantation of penile prostheses; dating service teen and venous or arterial surgery dating free service teen No effective oral therapy for chat dating room teen erectile dysfunction is currently available 6 Normal penile erection depends on the relaxation christian dating service teen of smooth muscles dating service teen in the corpora cavernosa In response to sexual stimuli, cavernous nerves and endothelial cells release nitric dating teen tip oxide, which stimulates the formation of cyclic guanosine monophosphate dating service teen (GMP) by guanylate cyclase 7-9 The mechanism dating service teen by which cyclic GMP stimulates relaxation dating service teen of the smooth muscles remains to be elucidated Sildenafil is a selective inhibitor of cyclic-GMP穆pecific phosphodiesterase type 5, the predominant isozyme metabolizing cyclic GMP in the corpus cavernosum dating service teen 10 By dating picture teen selectively inhibiting cyclic-GMP online free dating agency uk catabolism dating service teen in cavernosal smooth-muscle dating service teen cells, 11 sildenafil would be expected to restore dating teen tip the natural erectile response to sexual stimulation dating service teen but not E Downloaded from wwwnejmorg dating service teen on May 22, 2006 Copyright ゥ 1998 Massachusetts dating service teen Medical Society All rights reserved 1398  dating service teen May 14, 1998 The New England Journal of Medicine cause erections in the absence dating service teen of such stimulation Sildenafil is rapidly absorbed, with maximal plasma concentrations occurring within one hour after oral administration and a mean terminal half-life of three to five hours 10 In a placebo-controlled pilot study of 12 men, sildenafil significantly improved the erectile response during visual sexual stimulation dating service teen 10,12 We therefore undertook two studies to evaluate in a home dating service teen setting the efficacy and safety of sildenafil in men with erectile dysfunction METHODS In two sequential studies, we studied a total of 861 men 18 years of age or older dating service teen with a dating rule teen clinical diagnosis of erectile dysfunction (as black dating teen defined previously 1 ) of six months duration or longer dating service teen at 37 dating service teen centers in the United States Each man had to be in a stable relationship with a female partner that had begun at least six months earlier.

 

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The cause of erectile dysfunction was determined from the medical dating question teen history, physical examination, and dating service teen other diagnostic procedures, including a test involving the intracavernosal injection of a vasoactive drug (done in 31 percent of the men), a dating in minneapolis speed RigiScan test of nocturnal penile dating service teen tumescence (26 percent), penile duplex ultrasonography (21 percent), and endocrine testing (21 percent) On the basis of these evaluations, the men dating service teen were classified as having organic, psychogenic, or mixed erectile dating site teen young dysfunction Of the 861 men studied, 605 (70 percent) were judged to have organic erectile dysfunction, 99 (11 dating service teen percent) to have psychogenic erectile dysfunction, and 157 (18 percent) to have mixed erectile dysfunction Men were excluded if they had penile dating service teen anatomical dating service teen defects, a primary dating service teen diagnosis of another sexual disorder dating local service teen (eg, premature ejaculation), dating service teen spinal cord injury, any major psychiatric disorder not well controlled with treatment, poorly controlled diabetes mellitus, active peptic ulcer disease, a history of alcohol or substance abuse, major hematologic, renal, or hepatic abnormalities, or dating service teen a recent (within the previous six months) stroke or myocardial online dating agency in uk infarction or if they were receiving nitrate therapy Other erectile-dysfunction therapies were dating service teen discontinued at the time dating service teen of dating parent teen screening (four weeks before the subjects received the study medication) Sildenafil (Viagra) and an identical-looking placebo dating service teen were supplied by Pfizer dating service teen The men were instructed to take a dose approximately one hour before planned sexual activity but dating service teen not more than once daily The protocols were approved by the dating service teen institutional review dating service teen board at each center, and all the men gave written informed consent We assessed efficacy dating service teen by using the responses to question 3 (frequency of penetration) and question 4 (maintenance of erections after penetration) dating personals teen of the 15-question International Index of Erectile dating service teen Function, a validated, multidimensional, self-administered dating service teen questionnaire used for the clinical assessment of erectile dating service teen dysfunction and treatment outcomes in dating service teen clinical studies 11 The responses dating sex teen to these two dating service teen questions pertaining to the ability to achieve and maintain dating service teen an dating service teen erection sufficient for dating service teen sexual intercourse, as described in the definition of erectile dysfunction, 1 were rated dating service teen on a scale of 1 (almost never or never) to dating service teen 5 (almost always or always).

 

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A score of 0 indicated no attempt at sexual intercourse The mean score for each of advice dating teen the dating picture teen violence two dating service teen questions was 43 for 109 normal men, 31 to 86 years old, with an age dating service teen distribution similar to dating service teen that of the men with erectile dysfunction (unpublished data) Efficacy was also assessed on the basis dating service teen of the scores dating service teen for the five separate response domains of male sexual function dating service teen of the International Index 13 : erectile function (questions 1 through 5 and 15; possible total score, 1 to 30); orgasmic function (questions 9 and 10; dating service teen possible total score, dating service teen 0 to 10); sexual desire (questions 11 and 12; possible total dating service teen score, 2 to 10); intercourse satisfaction (questions 6, 7, and 8; possible total score, 0 to 15); and overall satisfaction (questions 13 and 14; possible total score, 2 to 10) The domain scores were dating service teen computed by adding the scores for the individual questions dating service teen in each dating service teen domain Other means dating service teen of assessing efficacy were an dating dating free online services teen service teen event log, in agency black dating online which we asked dating teen tip the men to record the date and dose of medication taken, the presence of sexual stimulation, the hardness of erections (graded on a four-point scale), and whether dating service teen sexual intercourse was successful, and dating service teen a global- efficacy question (泥id the dating service teen treatment improve your erections?), with a response of yes or no The end points of the International Index quantified the magnitude of the response, and the global-efficacy question and the event log provided qualitative dating parenting teen assessments of efficacy Physical examinations and standard dating service teen blood-chemistry and hematologic laboratory tests were performed dating service teen throughout the advice dating male teen studies Adverse agency dating internet online effects were recorded by dating service teen the investigators Study of Dose乏esponse, Efficacy, and Safety In this double-blind, placebo-controlled, fixed-dose study, 532 men were randomly dating service teen assigned to take placebo or 25, 50, or 100 mg of sildenafil (approximately one hour before planned sexual activity but dating minneapolis service not adult dating teen more than once daily) advice dating male teen for 24 weeks Each dose consisted of three dating service teen tablets from the same row of a blister pack (placebo dating service teen 朴lacebo朴lacebo; placebo朴lacebo25 mg; placebo朴lacebo 50 mg; or placebo50 mg50 mg).

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