Firstmed Blog

NEW YORK (Reuters Health) - Laboratory studies conducted at Queen’s University Belfast, UK suggest that taking the erectile dysfunction drug Viagra may adversely affect sperm function and possibly male fertility.

Recreational users of Viagra need to be informed of the drug’s potentially harmful effects on sperm function, the investigators say.

In their experiments, Dr. David R. J. Glenn and colleagues observed that exposure of cultured sperm to Viagra, compared to no exposure, led to a “sustained enhancement of motility,” both in numbers of progressively motile sperm and their velocity.

However, exposure to Viagra — at concentrations equivalent to the average maximum total blood concentration present 30 minutes after a single oral dose of 100 milligrams — also caused a premature “acrosome reaction.” Acrosomes are structures that cover the head of the sperm and contain a variety of enzymes that help the sperm penetrate the outer membrane of the egg.

That Viagra may induce early activation of the acrosome reaction has “important clinical implications because sperm that acrosome-react before contact with the oocyte are incapable of fertilization,” the researchers note in the journal Fertility and Sterility.

“Given that the majority of sperm acrosome react on exposure to (Viagra), the drug may cause significant impairment to their fertilizing potential,” they write.

This is a concern, Glenn and colleagues say, given that Viagra and other like-drugs are widely available on the Internet and are increasingly being used “recreationally” by young healthy men of reproductive age as sexual enhancers — not just by older men who have erectile dysfunction.

Source: Reuters

Conception results from the fertilization of the ovum by the spermatozoon or sperm. After ejaculation the sperms move towards the fallopian tubes and fertilization occurs in the fallopian tubes. The usual life of a sperm is estimated to be about 24 hours; while the ovum is estimated at 12 hours. So a coitus to be capable of fertilization, must take place within twelve hours of ovulation. That certainly explains why some married couples fail to conceive, though they are potentially fertile. The sexual activity should be able to coincide with the short time after ovulation, when the ovum is alive, so that chances of fertilization are there. And even then there are numerous factors like sperm mobility, viability of sperms, etc. before fertilization can eventually occur.

When does ovulation occur?
It has been concluded after considerable research that ovulation commonly occurs fourteen days before the onset of the next menstrual period. For example, ovulation will occur on the 14th or 15th day in a 28 days cycle, and on the 10th day in a 24 days cycle.

Is it always the female’s fault if conception is not occurring?
This is a misconception because conception depends upon the fertility of both. Any fault in either partner can lead to infertility. Studies have shown that 40% of infertility is due to the male partner.

What are the main causes of male infertility?
The commonest reason is a low sperm count, which can be attributed to various causes;
• Idiopathic, when we don’t know the exact cause.
• Varicose – It is a swollen varicose vein in the scrotum, most commonly on the left side. Blood accumulated in the swollen testicular veins leads to increased temperature in the testis and damages sperm production.
• Duct blockage – Infection like gonorrhea, TB, filariasis; on surgery for hernia/hydrocele may lead to blockage of the passage between the testes and the penis.
• Hormonal imbalance – Hormonal imbalance due to pituitary or adrenal gland can lead to infertility.
• Substance Abuse – Excessive intake of alcohol and/or drugs leads to decrease in liver function and increase in levels of the hormone Estrogen which in turn suppresses sperm production.
• Testicular factors – like twisting of testis leading to compromised blood supply.
People who work with harmful chemicals like lead, nickel, mercury, anesthetic gases, insecticides & pesticides and x-rays, are at increased risk of suffering from decreased sperm count.

Certain men have problems with ejaculation like problem having an erection (impotence) or inadequate erection for vaginal penetration.

Problems with erection can be due to psychological factors like performance anxiety, inhibitions against sex and due to physical factors like neurological defects, diabetes, inadequate blood flow to the penis, and also to certain hormonal problems.

A successful alternative that has come up is collections of sperms by masturbation which later can be used for artificial insemination.

Another problem with ejaculation that some men face is that the semen goes backwards into the urinary bladder instead of being ejaculated through the penis. This can occur in men who have had spinal injury or the ones suffering from diabetes, causing improper contraction of urinary bladder sphincter muscle.

Infections – another common reason for male infertility are infections like tuberculosis, Chlamydia, gonorrhea and syphilis. Mumps can lead to complications like testicular inflammation. Infections can damage the male reproductive tract leading to duct obstruction in some cases and decreased sperm production in others.

Breast cancer is regarded by most to be a woman’s disease, but it must be made clear that men are susceptible to breast cancer too. Men have all the same type of breast tissue that women do they just have fewer ducts and lobule (both of which are not as developed as they are in women). Cancerous cells can develop in this small amount of breast tissue in men. However breast cancer does occur much more commonly in women (less than 1% of breast cancers are male breast cancers).

The causes of breast cancer in men

The actual cause of breast cancer in men is not very well understood, but it seems as though some men are at a higher risk off developing it than others. Male breast cancer is rare and commonly occurs in men over the age of 60, and it is more common in men who have:

* Several close members of their family (male or female) who have had breast cancer, or
* A close relative being diagnosed with breast cancer in both breasts, or
* A relative diagnosed with breast cancer under the age of 40. It is also thought that having several members of the family with cancer of the ovary or the colon may also increase a man’s risk of developing breast cancer.

Many Family cancer genetic clinics run for those who may have an increased risk of developing cancer because of a history of cancer in the family. Your GP may refer you to one of these clinics if they feel that you are at an increased risk of developing male breast cancer.

In certain circumstances (which are rare) men with high levels of the female hormone oestrogen or men who have been exposed to repeated doses of radiation (particularly when young) may be at an increased risk of developing breast cancer. Also Men who suffer from Klinefelter’s syndrome (a rare genetic condition where an extra female X-chromosome is present) have a higher than normal risk of developing breast cancer.

Types of Breast cancer in Men

Different types of cancer can affect the male breast. The most common type is called invasive ductal carcinoma, which is also the most common type of breast cancer affecting women. Other rarer types of cancer are inflammatory breast cancer, Paget’s disease of the breast and ductal carcinoma in situ (DCIS).

Physical, tactile, stimulation of the penis arouses and activates the sensory nerve fibres on the surface of the penis. Specialised nerve fibres (called afferent fibres) carry this sensory information from the touch receptors on the penis to the spinal cord. This information is then passed along the spinal cord to the brain. The brain processes this stimulatory information and sends out pro-erection signals (signals that trigger erections) back down to the penis via efferent fibres. These efferent signals form the brain stimulate the dilation (widening) of the Pudendal artery (shown in figure 2). This leads to a net increase in blood flow to the penis and produces an erection. This type of erection is referred to as a reflexogenic erection.

There can be various problems in this route from the Penis to brain and Brain to Penis, problems in this pathway can result in impotence due to a physical cause. One such example is in males who haven’t undergone circumcision . In these men the foreskin of the erect penis may be very tight and immobile on the shaft. This can interfere with the normal erection process and result in poor erectile functioning. This condition is known as Phimosis.

The process of achieving an erection is a very complex one involving multiple inputs from various areas of the brain and the nervous system (spinal cord). The nervous system plays a very important role in penile erection. The nervous system is involved in the creation of an erection and process of ejaculation itself. The first part of the penile erection is controlled by the brain and is referred to as a psychogenic erection and occurs in any sort of mental or erotic stimulation. However erections of the penis can also be caused by stimulation of the skin of the penis alone (e.g. by touch), this sort of erection is known as a reflexogenic erection. Erections of this sort occur more commonly in men who have damaged their spinal cord and are unable to achieve an erection unless physically stimulated.

The Brain plays a big part in regulating sex drive and in a mans ability to achieve erections. A part of the brain known as the limbic system is very important in psychogenic erections; it is the part of the brain responsible for processing sexual thoughts. These sexual thoughts are processed in and handled by the limbic system in the brain. They are then passed along to the penis via the spinal cord. There are numerous connections between the spinal cord and the penis; they go from the spinal cord to the penis (efferent connections) and from the penis to the spinal cord (afferent connections). These nerves from the spinal cord play an important part in controlling erections. For this reason it is important that these nerves receive sufficient input from higher centres (such as the limbic system in the brain). If a man loses his ability to process sexual thoughts in the brain and is unable to pass these signals along the spinal cord to his penis, it can result in his impotence; this is referred to as psychogenic impotence (impotence due to a psychological cause). This problem can usually be corrected with psychological help. If you are really concerned and feel as though your erectile dysfunction could be due to a psychological cause then it is advised you go and speak to your General Practitioner (GP) who will be able to give you the necessary advice and information.

It is defined as the inability to fertilize the ovum, while male sterility is defined as the lack of sperm production.

Many factors can influence a man’s fertility such as:

Having a history of past illnesses including STD’s, mumps, undescended testes, structural or anatomical problems.
Seminal duct blockages or presence of a variocele
Prescription drugs, antihypertensives and anti-inflamitories reduce sperm count. Antihistamines decrease the amount of seminal fluid
Abnormalities of sperm count, mobility or morphology
Lifestyle factors including: Stress, lack of sleep, poor diet, or overuse of alcohol, nicotine or marijuana
Immune factors i.e.: antisperm antibodies which kill sperm before they can reach the egg
Low testosterone levels or other endocrine related issues
Testicular trauma

How is infertility diagnosed?
When male infertility is suspected the first tests performed will be a semen analysis. This evaluates the three major areas of sperm quality and quantity.

Sperm count: normal range is forty to three hundred million per milliliter of ejaculate; a low sperm count is fewer than twenty million per milliliter of ejaculate

Motility: low sperm motility may reduce the chances of conception especially when combined with a low sperm count

Morphology: sperm which do not have normal morphology are unable to swim effectively to penetrate an egg Sperm chromatin structural assay measures the level of DNA fragmentation in the sperm which studies suggest may serve as a predictor of reduced male fertility

Treatment of male infertility
Treatment of male infertility focuses on assisted reproduction techniques, primarily intrauterine insemination or in vitro fertilization. Surgical intervention may be required to treat structural problems such as large varioceles.

Chinese Medical Treatment of male infertility
Chinese medicine can help the body to increase sperm production and quality and to resolve hormonal factors that may be affecting a man’s fertility. Mechanical blockages can be improved by using abdominal massage, herbs and acupuncture, particularly in cases in which surgery is not required. Increased blood flow to the pelvic organs can improve sexual function as well as fertility issues.

Frequent bus users could be more at risk of impotence due to drivers’ sudden braking, a health expert in Peru has claimed.

Livinginperu.com reported that combi (minibus) drivers who brake suddenly may be endangering their passengers and causing micro-traumas in their veterbrates, according to Doctor Liam Scubel, the chief of Peru’s Chiropractor’s Alliance.

He told Andina News Agency: “Micro-trauma can progressively move vertebrates out of place, thereby causing excessive pressure on the nerves.

“In the long run, this pressure can cause a series of health problems such as inflammation of the sciatic nerve.”

He added that travelling in combis can cause problems in the prostate as well as headaches and nervousness.

Regular passengers should sit in individual seats rather than bench seats and tall people should avoid standing up inside small buses, he concluded.

Micro-trauma can include the micro-tearing of muscle fibres, the sheath around the muscle and the connective tissue, but can also be used to refer to stress to the tendons and to the bones.

The Penis itself is a spongy organ and when relaxed feels soft and smooth, when the penis is in this state it is referred to as being “flaccid”. To understand how an erection takes place we need to understand the structure of the penis, this is shown simply in figure 1 and explained in detail below.

The penis is a tube like structure composed of three cylinders, two of which are paired. These two paired cylinders are called the corpora cavernosa and are responsible mainly for the erectile functioning of the penis. A tough thick membrane covers the penis, so when the penis fills with blood this membrane helps create a firm structure that allows penetration. The third cylinder of the penis is known as the corpus spongiosum. The corpus spongiosum runs centrally through the penis and contains the urethra (duct through which urine is discharged). It is these three sponge like cylinders which fill with blood to produce an erection.

Physiologically an erection takes place when there is an increase in blood flow into the penis and a decrease in flow out of it. This causes the penis to become engorged with blood and enlarge producing an erection. To understand this mechanism fully we must look at the blood supply to the penis. Blood enters the penis via a blood vessel known as the Pudendal artery and leaves via the dorsal vein as shown in figure 2 below:

As Figure 2 illustrates the blood vessels pass through the Corpora Cavernosa. The Corpora Cavernosa is cylindrical in structure and has a sponge like property. When an erection takes place these blood vessels dilate and blood flows into the Corpora Cavernosa via the Pudendal artery. The Corpora Cavernosa acts according to its sponge like properties and “soaks up” this blood. At the same time the outflow of blood from the penis is reduced by compression of the dorsal vein following the increase in pressure within the Corpora Cavernosa. This leads to an overall increase in blood to the penis and results in an erection. The Corpus Spongiosum (the third cylinder in the penis) is less turgid than the Corpora Cavernosa and plays a crucial part in protecting the urethra (mentioned earlier) during erections. During the process of an erection as the blood flow changes the penis goes through three phase or stages. These are Flaccidity, Tumescence and erection. These three stages are shown below in figure 3.

BOSTON, May 21 /PRNewswire-USNewswire/ — Researchers have found that men who drink an average of four to seven glasses of red wine per week are only 52% as likely to be diagnosed with prostate cancer as those who do not drink red wine, reports the June 2007 issue of Harvard Men’s Health Watch. In addition, red wine appears particularly protective against advanced or aggressive cancers.

Researchers in Seattle collected information about many factors that might influence the risk of prostate cancer in men between ages 40 and 64, including alcohol consumption. At first the results for alcohol consumption seemed similar to the findings of many earlier studies: There was no relationship between overall consumption and risk. But the scientists went one step further by evaluating each type of alcoholic beverage independently. Here the news was surprising — wine drinking was linked to a reduced risk of prostate cancer. And when white wine was compared with red, red had the most benefit. Even low amounts seemed to help, and for every additional glass of red wine per week, the relative risk declined by 6%.

Why red wine? Doctors don’t know. But much of the speculation focuses on chemicals — including various flavonoids and resveratrol — missing from other alcoholic beverages. These components have antioxidant properties, and some appear to counterbalance androgens, the male hormones that stimulate the prostate.

Many doctors are reluctant to recommend drinking alcohol for health, fearing that their patients might assume that if a little alcohol is good, a lot might be better. The Harvard Men’s Health Watch notes that men who enjoy alcohol and can drink in moderation and responsibly may benefit from a lower risk of heart attack, stroke, diabetes, and cardiac death.

Source: PR Newswire

Eli Lilly, developer of erectile dysfunction medication Cialis as well as depression drug Prozac, has today announced the winners of its Welcome Back Awards for 2007.

The group’s independent committee of mental health leaders selects five honourees each year for their outstanding commitment to helping others within the depression community.

This year, Karen Swartz has been acknowledged for her work in psychiatry, alongside Sara Valentino for her primary care efforts, Thomas S Stanage for community service and Sylvia Axelrod for helping to destigmatise the condition.

Roberto Lewis-Fernandez, managing director of the committee and associate professor of clinical psychiatry at New York’s Columbia University, said: “Each honouree recognises that mental illnesses affect more than just the individuals diagnosed with them - they impact the surrounding community as well.”

He added that the honorees are “proud” to inform people about depression, therefore removing its stigma and increasing knowledge of its treatment options.

Psychiatrist.com reported that “erectile dysfunction and the psychological distress that accompanies it” can lead to depressive illness in vulnerable individuals, while vice versa, depression can cause erectile dysfunction.