Best Medicine for Migraines

Neither all the pains of ridge are migraines, neither all the migraines cause headaches.  The migraine or headache is one of the most common forms of pain.  Although its cause is a stranger, the pain that itself produces it due to an enlargement of the arteries situated in the skull.  · Types

Diverse types of migraines exist: the migraine with breeze is preceded of alterations of visual, as in the country visual black spots or vision of points or luminous lines.  The migraine accompanied appears with loss of force in the half of the body or with alterations in the central nervous system.  Another type of migraine, without migraine, is characterized for vomitings, queasiness and demolition, without headache appearing.  The 90 percent of the patients that suffer the most frequent types of migraine, that are:  – Migraine of tension: is a light pain or moderate.  It can be caused by the stress, bad positions, fatigue or depression.

- Migraine of bunch:  Is more frequent in women.  Is a matter of a pain in one of the sides of the head that extends until arriving al eye.  Can last some 15 minutes and often occurs at night.

- Migraines or headaches:  It constitutes an assembly of symptoms among the ones that they are found, besides the headache, vomitings, queasiness, sensibility to the light and al noise.  The migraines are inconveniences that have hereditary base.  The pain is used to locating in a part of the head or in all.

It has a character pulsátil and a discomfort generalized accompanies by itself.  This pain gets worse normally with the physical activity and improvement with the rest.  It affects to 17 of each 100 women and to 5 percent of the men.

· Causes

The exact causes of the migraines do not know themselves, although several theories have been studied.  At present is believed that the migraine is a constitutional inconvenience with genetic base.  The triggering causes are difficult to identify and different in each people, but the most frequent are:  – Inheritance:  Although the form of inheritance is not totally established, in some special forms of migraine already identifying the gene has itself that transmits it situated in the chromosome 9.

- Age:  In the infancy the migraine is presented equally in children and girls.  From the pubertad and due to the hormonal changes, itself unlike the incident of migraine in the women.

- Stress and anxiety:  It is necessary to learn to be relaxed, to seek some distraction in stressful moments.

- Hormones:  It more frequent is to suffer one or two crisis al month, fundamentally in the epoch of spring and autumn, and these can come they last from 4 to 72 hours.  Besides the intense headache these pains go accompanied by other symptoms as queasiness, fotofobia or vomitings.  In smaller measure they can cause irritability, anorexia, vertigos and sicknesses.  The migraine is used to getting worse with the ovulation and the menstruation, as well as with it takes of contraceptive oral.  The embarrassment, nevertheless, is used to improving transitorily the migraine and many women improve extraordinarily when disappears the menstruation (menopause).

- Consumption of alcohol and diet:  Some food and beverages can unchain attacks of migraine.  For example, the alcohol, especially the red or burgundy wine; the foods with glutamate monosódico MSG; products that contain tiramina; or the meats in preserve with nitrates.

- Lack or excess of dream:  Can also be a cause of the migraine.

- Environmental Factors:  The time or the changes of temperature, the dazzling lights or the fluorescent, the screens of computer, the strong smells and the high altitudes.

Processing

Although all the migraines are associates with the pain, they differ in their severity and their frequency.  Because of it it is necessary to create a processing to the extent that attend the individual needs of each sick one.

The medicación intense is an employee to treat specific migraines and they should be used quickly in the initial phase.  From time to time are also cash for the reduction of other symptoms of the attack, like the queasiness, the vomitings or the sensibility al noise or the light.

The preventive therapies are employees of daily form to prevent the attacks or to reduce their frequency and severity.  Inside these therapies they are found the pharmacological and the not pharmacological, as the physical therapies and of behavior.

Finally, the medicines of rescue apply when the medicación intense fails.  Generally they are able administered at home, although some more aggressive therapies than require injections intramusculares or intravenous are given in the medical doctor’s office or in the service of ER.  This processing can cause drowsiness, what turns out to be adequate to alleviate the pain, although some patients complain because impedes them to continue with its routine activities.

Four different agents for the individual processing of the migraines exist:  – Analgesic.

- Antieméticos.

- Ergotamina.

- Triptanes.

Some processing combine various agents, but its abuse can intensify the problem instead of alleviating it.

Besides several not pharmacological therapies exist that are being utilized with success in the approach or prevention of the migraines:  – The therapy of retroalimentación electric monitors the sensations of the body, since the temperature to the muscular tension.  They known this information, the patient tries to improve the control on the muscular tension and the temperature in order to eliminating the associated symptoms to the migraines and to reduce the frequency and severity of the attacks.

- Cognitive Therapy: consists of learning to control the thoughts and to reduce those of nature negative.  This permits that the sick one control the stress and the situations in which is probable that an attack unchain itself.
The migraines in children

Before the pubertad there is not you differentiate between the quantity of children and girls that suffer migraines, but after this phase of the life the migraine is a lot more common in the adolescents.

In some occasions they finalize in the adolescence, but they can return when the adult age is reached.

The smallest children are used to suffering migraines in the two parts of the head, while the greater are used to feeling it in a part only.  Fortunately the attacks are shorter in the children that in the adults.  The more common symptoms related in the children are the nausea and the vomitings, the diarrhea, an increase of the need to urinates, sweat, thirst, and swelling.  The “breezes” visual are not so common in the children as in the adults.

Often the headaches caused by the migraine are reduced in a year, even without processing.  Al the same as in the adults, one must identify and to avoid the factors that cause the crisis or promote them.

The doctors are used to recommending to maintain a fixed hour to be gone to bed and to eat and to avoid an overload of activities.  The not pharmacological processing, like the biorretroalimentación or the techniques of relaxation are recommended especially in the children of this age, that are used to being more receptive to these therapies that the adults.

If it were necessary the processing with medicines, the doctor will begin employing a single analgesic one.  The combinations of these medicines that are employed in the adults themselves recetan in smaller dose.

Depending on the frequency, duration and intensity of the headaches, and of the answer of the boy al analgesic, is able recetar a plan of preventive pharmacological processing.

· Counsels to keep in mind

- To Maintain a newspaper.  In it it should be written the following thing:  * The date and the moment in which begins each migraine and its duration * Any another sign of migraine, such as
queasiness, vomitings, sensibility to the light, sound or smells; or breeze.

* Any cause that can cause an attack.

* In the women, the day of beginning of the menstrual period.

With all that information, a doctor will be able to identify the boss of the headaches and to adjust the processing.

- To Ask a friend or family that help to watch the symptoms of notice of the headaches.  These symptoms of warning can occur at any moment, well few hours, or few days before the headache comience.  They can be various: thirst; yawns, fatigue, depression, elation, irritability, sicknesses, sensibility to the lights or sounds, stiff neck, the greater need cold feeling of urinates, diarrhea, constipation… – to Have always with himself a dose of the medicines prescribed by the doctor and to take the medicines of the form described by the doctor – to Consume only the medicines prescribed by the doctor.  Utilize not higher dose of them recommended.  Stop not
taking them without consulting before with the doctor.  Some medicines one must leave to consume them gradually to avoid secondary effects done not desire.

- If itself not a dose has been able to be taken, to do it as quick as be possible -except if is the moment of it takes of the following one.  In that case to forget the previous one, since themselves should not double the quantities recommended.

- After taking a medicine against the migraines, be fallen in the darkness, in a silent room until the pain comience to improve.

- Recall that you and their doctor are associates in its care.  It is for its well to continue the counsels of its doctor, and to do all the changes in the way of life that can help to control the migraines.

What should be done when they begin to be noted symptoms of anxiety?

In the first place one must rule out the possibility of any illness of organic character, by means of opportune the analyses.

Once specific that the origin is of psychological type, agrees to do a serious reflection on the type of life that is being carried.

One must see if the rest is adapted, that is to say, if a number of acceptable hours sleeps and if the schedules are regular.  If this it is not thus, one must correct it and to establish some schedules that normalize this situation.

It agrees to determine if the way of life is excessively sedentary.  If it is thus, agrees likewise to dedicate some hours to some type of activity or physical exercise.

More important still than the previous points the form results in which the situations problem are confronted.  One must avoid all kinds of anticipations or thought on the anxiety, being this the most important cause of the maintenance and growth of said anxiety, causing still greater insecurity.  They agree to act with naturalness; the more the possible signs of anxiety be observed, more probable will be that this occur.

In some occasions, the first indications of the beginning of an anxiety attack, they are used to declaring by means of a light tickling in the hands.  This signifies that there is an excess of oxygenation caused by hyperventilation as already we have explained.  At this time ideal results the respiration diafragmática, slow respiration, retaining the air with the inspiration and expelling it with possible the greater slowness.  It ideal is to inspire filling the lungs al maximum at the same time that we observe how enlarges the volume of our abdomen, to retain a little the air and immediately to expel it slowly, in such a way that the expiration last approximately the double one that the inspiration.  From time to time a plastic bag is utilized to breathe inside her, in such a way that after some minutes manages to reduce itself the level of oxygen in the agency and disappears the sensation of tickling.

Another symptom anticipatory is used to being a sudden sensation of loss of equilibrium, sickness or instability.  In these situations, is recommendable not to set the attention in our body and on the contrary, to get into focus toward the outside.  For example, to direct the view toward somewhat distant, trying to identify it, can help to recover or to maintain the equilibrium.  It is a matter of directing the visual attention in a different direction to our body.  Likewise this same exercise with the remainder of the senses can be done, focusing them always toward the outside, never toward our body.  Trying to identify distant sounds, cars, voices or any another thing, can be a valid system to manage to blur our attention of the problem.

One must dedicate the time that be necessary to manage to relax.  Once it has managed to avoid or to reduce the situation of crisis, is not useless always to gratify us with some small satisfaction.  After all the correct execution of these instructions, requires a certain training and to obtain the adequate result, is an achievement that approaches us toward the future control of our body and therefore to the solution of the problem.

How to control Anxiety

Which they are the techniques of processing more habitually utilized?

There are studies that show that the combination of the cognitive therapy conductance along with certain pharmacological, has effectiveness in approximately the 80 ó 90 percent of the people with inconveniences of panic. Generally it is used to appreciating a significant improvement approximately 6 to 8 weeks after to have initiated the processing.

As it indicates the neurologist Framework Battaglia of the University of San Raffaela of Milan, “psychology and biology are intimately you tied”. Battaglia and its team they have done public this month from February the discovery that to block the phenacetins, a neurotransmitter up to now related to regenerative illnesses as the Parkinson, all patient of certain symptoms could be managed to immunize temporarily like the sensation of I drown that accompanies always attack of panic. Nevertheless, these medicines concretely, they present a series of damaging secondary effects, that dissuade completely its utilization, unless until its effectiveness be greater that the effects collaterals that carry associates.

On the other hand, the pharmacological that generally are utilized in the processing of the inconveniences of anxiety, although they are curative in no case, can be troops to mitigate the symptoms of the anxiety, which at times is indispensable and in this sense to favor the healing.

Inside the technical conductances, one of the most utilized for the processing of the inconveniences of anxiety, is the training in respiration diaphragmatic. It is a matter of a type of consistent respiration in the execution of deep and slow respiration, that mobilize more the abdomen, causing working more diaphragm and permitting thus a greater oxygenation in the lower part of the lungs, but that above all reduces the general excess of oxygen caused by the hyperventilation that the people that suffer from anxiety present often. When the anxiety attack is produced, the agency begins to hyperventilate, that is to say, to carry out a series of superficial and fast respiration, that permit the entrance of small quantities of air, at the same time that large quantities of oxygen that can cause taquicardias, sicknesses and other symptoms, like tickling in the peripheral members, hands or feet, etc.

On the other hand, the cognitive therapy conductances, intends to teach the patients to interpret the stimuli of different form from that is to say, to react of different form in the situations and before the corporal sensations that they untie the attacks of panic and other symptoms of anxiety. One of the main objectives of the cognitive therapy conductances, is to teach all patient to see the situations of panic in a different way, as well as to teach him different media to reduce the symptoms of the anxiety. The patients learn to understand the form in which their way to think contributes to their symptoms and how to change their thoughts to diminish the possibility that these symptoms be repeated. For example, someone that during the attack of panic declares to have large sicknesses and he fears or he has the sensation that he is going to die, can receive aid with the following technique: Him it is asked al patient that give returns in a same place until make dizzy itself. This will do that be familiarized with the symptom of the sickness, not associated al attack of panic. When nevertheless, the patient be before a crisis he would begin to think: “I am going to die”, nevertheless, he there will be learned to replace that incorrect thought, by another more appropriate one as “he is not but that a small sickness and I can control it”.

Another technique that is used in the cognitive therapy conductances, known like insensibility systematic, consists of exposing little by little the people to the situation feared in consequence of the inconvenience of panic, until they come they be done unfeeling to her. When the crisis of panic unchains more than one time in a same place by example in a great store), from time to time occurs that this subject develops besides, a specific phobia to that place, that is to say, is incapable to enter any great store. In these cases is used to being cash this technique, that basically consists of the gradual exposition of the patient to the situation. This technique should be guided and directed by a specialist (psychologist generally), that know exactly how, in what moment and in what measure one must expose al subject to the situation.

Without doubt, the worse thing than can cause is to try to avoid those situations in which one believes that would be able to happen the crisis. That conduct would be able to come to produce what agoraphobia is called the one that we would be able it to define as the fear that has to suffer an anxiety attack or attack of panic in situations of defenselessness, that is to say, in those situations in which the subject feels unprotected completely. This, only not it would not solve the problem, but on the contrary would increase it.

Depression

Depression

Information of the health according to the National Institute of the Mental Health (NIMH acronyms in English), each year, the 9.5 percent of the American population (approximately 18.8 million American adults) suffers of depressive illnesses.  Unfortunately, many people do not know that the depression is a treatable illness.

NIMH says that the depressive inconvenience is an illness that affects the agency (brain), the spirit, and the way to think.  It affects the form in which a person eats and he sleeps.  It affects how one values to itself (self-esteem) and the form in which one thinks.  A depressive inconvenience is not the same thing that a passing state of sadness.  Does not it indicate personal weakness.  Is not a condition of which one can be freed voluntarily.  Types of depression

Al the same as in other illnesses, for example the illnesses of the heart, various types of depressive inconveniences exist:

* Severe Depression.  The severe depression is declared for a combination of symptoms that interfere with the capacity to work, to study, to sleep, to eat and to enjoy activities that before were pleasant.  An episode of very incapacitating depression can occur only once in the life, but generally occurs several times of the life.  * Distimia.  The distimia, a type of depression less serious, includes long-term chronic symptoms, that do not incapacitate so much, nevertheless inpiden the good operation and the welfare of the person.  Many people with distimia can also suffer of severe depressive episodes in some moment of their life.  * Bipolar Inconvenience.  Another type of depression is the bipolar inconvenience, call also manic depressive illness.  Is not as frequent as the other depressive inconveniences.  The bipolar inconvenience is characterized for cyclic changes in the state of spirit: high or ecstatic phases of spirit (mania) and phases of low spirit (depression).  The spirit state changes can be dramatists and fast, but most often they are gradual.  When a person is in the depressive phase of the cycle, he can suffer of one, of various or of all the symptoms of the depressive inconvenience.  When he is in the manic phase, the person can be hyperactive, to speak excessively and to have a large quantity of energy.  The mania often affects the way to think, the judgment and the way to be behaved with relation to the other.  It can carry to that the patient put himself in serious problems and embarrassing situations.  For example, in the manic phase the person can be felt happy or ecstatic, to have magnificent projects, to make decisions of absurd business, and to be involved in adventures or romantic fantasies.  If the mania is left without treating can get worse and to be become a state sicótico (the patient loses temporarily the reason).  * Postpartum Depression.  The women should be on the alert of mental changes that can occur, during the embarrassment and after the labor.  The American Academy of the Family Doctor reports that the symptoms of what more commonly him is called “baby blues” they can begin from three to four you gave after the labor, and this includes changes of temperament, the to cry suddenly and the problems of concentration.  These symptoms disappear for it to regulate ten days after the labor.  But if they are prolonged or they intensify, him is called postpartum depression and can need helps medical.  (Read on “Healthy Embarrassment”)

Symptoms of depression and mania

NIMH says that not all the people that are in depressive phases or maniacs suffer of all the symptoms.  Some they suffer of a few symptoms, other they have many.  The gravity of the symptoms varies according to the person and can also vary with the time.

Depression:

* They Been of anxious, sad spirit or “empty” in persistent form.  * Feelings of despair and pessimism.  * Feelings of fault, uselessness and impotence.  * Loss of interest or pleasure in hobbies and activities that before enjoyed themselves, including the sexual activity.  * Decrease of energy, fatigue, exhaustion, sensation to be “in slow camera.”  * Difficulty in being concentrated, to recall and to make decisions.  * Insomnia, to be awoke earlier or to sleep too much.  (Read on “The Dream”) * Loss of weight, appetite or both, or on the contrary to eat too much and increase of weight.  * Thoughts of death or suicide; suicide attempts.  * Anxiety, irritability.  * Persistent physical Symptoms that do not respond al medical processing, like headaches, digestive inconveniences and other chronic
pains.

Mania:

* Abnormal or excessive Elation.  * Unusual Irritability.  * Decrease of the need to sleep.  * Ideas of greatness.  * Excessive Conversation.  * Rapid Thoughts.  * Increase of the sexual desire.  * Energy excessively increased.  * Lack of judgment.  * To be Behaved in inappropriate form in social situations.

You cause of the depression

Some types of depression tend to affect members of the same family, which would suggest that a biological predisposition can be inherited.  This seems to be given in the case of the bipolar inconvenience.  The studies of families with members that suffer of the bipolar inconvenience in each generation, they have found that those that are made ill they have a somewhat different genetic constitution of who they are not made ill.  Nevertheless, not all the ones that have the genetic predisposition for the bipolar inconvenience suffer it.  Al to seem, there are other additional factors that contribute to that the illness unchain itself: possibly tensions in the life, problems of family, work or study.

In some families the severe depression is presented generation after generation.  (Read on “Historical of Family Health”) nevertheless, the severe depression can also affect people that do not have a family history of depression.  Be hereditary or not, the severe depressive inconvenience is often associate with changes in the structures or cerebral functions.

The people with little self-esteem are perceived to itself and they perceive al world in pessimistic form.  The people with little self-esteem and that are overwhelmed easily by the stress they are predispuestas to the depression.  Itself it is not known with certainty if this represents a psychological predisposition or an early phase of the illness.

In recent years, the scientific investigation has shown that some physical illnesses can lead to mental problems.  Illnesses such as the accidents brain-vasculares, the attacks of heart, the cancer, the illness of Parkinson and the hormonal inconveniences, they can carry to a depressive illness.  (Read on “Apoplexy” “Attack al Heart” “Cancer:  What Signifies” “Illness of Parkinson”)

The sick person and depressed feels lackadaisical and without desires to attend to its own physical needs, which prolongs the period of recovery.  The loss of a to be wanted, the problems in a personal relation, the economic problems, or any stressful situation in the life (situations desired or done not desire) can also precipitate a depressive episode.  The causes of the depressive inconveniences generally include a combination of environmental, psychological, and genetic factors.  After the initial episode, other depressive episodes almost are always unchained for a light stress, and even they can occur without there be a situation of stress.

Diagnostic evaluation and processing

The first step to receive an adequate processing for the depression consists of a medical exam.  Certain medicines, as well as some illnesses, for example vital infections, can produce the same symptoms that the depression.  The doctor should rule out those possibilities through a physical exam, interview of the patient and analysis of laboratory.  If you cause physical they are ruled out, the doctor should carry out a psychological evaluation or to direct al patient to a psychiatrist or psychologist.

The selection of the processing will depend on the result of the evaluation.  A great antidepressants medicines variety exists and psicoterapias that can be utilized to treat the depressive inconveniences.

Many forms of psicoterapia, even some short-term therapies (10-20 weeks), they can be useful for the patients depressed.  The therapies “of conversation” help the patients to analyze their problems and to resolve them, through a verbal exchange with the terapeuta.  Some times these talks combine with “tasks to do at home” between a session and another.  The professionals of the psicoterapia that utilize a therapy “of behavior” try to help that the patient find the form to obtain more satisfaction through its own actions.  Also they guide al patient so that abandon bosses of conduct that contribute to their depression or that are consequence of their depression.

There are various utilized antidepressants medicines types to treat depressive inconveniences.  These they include the “inhibiting selective of the reclaiming of serotonin” (SSRI acronyms in English) that are new medicines, the tricíclicos and the “inhibiting of the monoaminoxidasa” (MAOI acronyms in English).  Never they should combine medicines of any type – recetados, without prescription or lent – without consulting al medical.  Any another professional of the health that be able recetarle a medicine (for example the dentist or another specialist) has to know what medicines he is taking the patient.  Although some medicines are harmless when they are taken alone, if they are taken in combination with other they can cause dangerous secondary effects.  Some substances, like the alcohol and the drugs of addiction, they can reduce the effectiveness of the antidepressants and therefore they should be avoided.  The questions on the antidepressants recetados and problems that can be related to the medicine, they should be treated with their doctor.

Viagra – Erectile Dysfunction

The at times called, erectile dysfunction “impotence,” is the incapacity repeatedly to achieve or to maintain an erection it sufficiently sign as to have a sexual relation. The word “impotence” can also be used to describe other problems that interfere with the sexual relation and the reproduction, such as the lack of sexual desire and the problems with the ejaculation or the orgasm. The use of the words erectile dysfunction leaves in clear that those other problems are not implied.

The erectile dysfunction, or OF, can be a total incapacity to achieve an erection, an unstable capacity to do it, or a tendency to have only brief erections. These variations do difficult to define that of and to calculate their incident. The calculations vary since 15 to 30 million, depending on the definition used. According to the survey of National Ambulatory Medical Attention (NAMCS, acronyms in English), by each 1,000 men in the United States, 7.7 visits were done al medical doctor’s office by OF in 1985. In 1999, the frequency almost had trebled to 22.3. The increase was produced gradually, presumedly to the extent that they were put available more extensively the processing such as devices of empty and injectable medicines and began to be accepted the discussion of the erectile dysfunction. It is possible that the most publicized advance was the introduction of the medicine oral citrate of sildenafil (Viagra) in March of 1998. The data of NAMCS on new medicines show a calculation of 2.6 million mentions of Viagra in visits al doctor’s office I medicate in 1999, and a third of those mentions they took place during visits for a diagnosis done not relate to OF.

In the older men, that of generally has a physical cause, like an illness, wound, or secondary effects of medicines. Any inconvenience that cause a wound in the nerves or that deteriorate the flow of blood al grieve can cause OF. The incident enlarges with the age: around 5 percent of the 40-year-old men and between the 15 and the 25 percent of the 65-year-old men they experience OF. But is not an inevitable part of the aging.

That of is treatable to any age, and the knowledge of this fact has gone growing. More men have sought aid and returned to the normal sexual activity due to processing improved and successful of that of. Traditionally the urologists, who they specialize themselves in problems of the urinary ways, they have tried that of; nevertheless, the urologists only are 25 percent heads of the mentions of Viagra in 1999.

How an erection occurs?

The penis contains two cameras called cavernous bodies, which occupy the long one of the organ (see the figure 1). A full spongy weaving the cameras. The cavernous bodies are surrounded by a membrane, call robe albugínea. The spongy weaving contains smooth muscles, fibrous weavings, spaces, veins and arteries. The urethra, that is the channel for urinates and to ejaculate, occupies the long one under the cavernous bodies. Illustration of two penises

It figures 1. The arteries (up) and veins (down) penetrate in the full and long cavities that are located along the penis—the cavernous bodies and the spongy body. The erection occurs when the relaxed muscles permit that the cavernous bodies be filled with blood excessively fed by the arteries, while the drainage of blood through the veins is blocked.

The erection begins with the mental stimulation and of the senses, or both. The impulses of the brain and the local nerves do that the muscles of the cavernous bodies relax, permitting that flow the blood and fill the spaces. The blood creates pressure in the cavernous bodies, doing that the penis be expanded. The robe albugínea helps to trap the blood in the cavernous bodies, with it maintaining the erection. When the muscles of the penis contract to stop the flow of entrance of the blood and to open the flow at the outset of the channels, the erection reverts itself.

What cause that of?

Due to that an erection requires a precise sequence of events, OF can happen when any of the events is interrupted. The sequence includes impulses of the nerves in the brain, the backbone, and the area around the penis, and answers of the muscles, fibrous weavings, veins, and arteries in and near the cavernous bodies.

The most common cause of OF is the damage to the nerves, arteries, smooth muscles and you woven fibrous, often as a consequence of an illness. Illnesses such as the diabetes, enermedades of the kidney, chronic alcoholism, multiple sclerosis, ateroesclerosis, illness vascular and neurological illness—they are responsible for around 70 percent of the cases of OF. Between the 35 and the 50 percent of the men with diabetes they suffer from OF.

Also, the surgery (especially the radical surgery of prostate due to cancer) can injure nerves and arteries near the penis, causing OF. A wound in the penis, the backbone, the prostate, the bladder and the pelvis can carry to to produce wound in the nerves, smooth muscles, arteries and fibrous weavings of the cavernous bodies.

Besides, many common medicines—medicines for the arterial pressure, antihistamínicos, antidepressants, soothing, suppressors of the appetite, and cimetidina (a medicine for the ulcer) —they can cause OF as secondary effect.

The experts think that psychological factors as stress, anxiety, fault, depression, low self-esteem and fear of failure in the sex cause 10 to 20 percent of the cases of OF. The men with a physical cause of OF often experience the same type of psychological reactions (stress, anxiety, fault, depression).

Other possible causes are to smoke, that affects the blood flow in the veins and arteries, and abnormalities in the hormones, as insufficient quantity of testosterone.

How it is diagnosed that of? Antecedents of the patient

The sexual and medical antecedents help to define the degree and the nature of that of. A medical record can reveal illnesses that carry to that of, while a simple story of the sexual activity can distinguish among problems with sexual desire, erection, ejaculation or orgasm.

The use of certain illegal drugs or medicines recetados can suggest a chemical cause, since the effects by medicines are 25 percent heads of the cases of OF. Utilizing less or to substitute certain medicines often can alleviate the problem. Physical exam

A physical exam can give trails on problems sistémicos. For example, if the penis is not sensitive al touch, the cause can be a problem in the nervous system. Characteristics of abnormal secondary sex, such as the distribution of the hair, they can indicate hormonal problems, what would signify that the endocrine system is implied. The examiner would be able to discover a circulatory problem if observed pulses diminished in the wrist or the ankles. And characteristic unusual of the same penis they would be able to suggest the origin of the problem—for example, a penis that doubles or curve when is erect could be the result of the illness of Peyronie. You test of laboratory

Diverse tests of laboratory can help to diagnose that of. The tests for illnesses sistémicas include recounts of blood, analysis of urine, profile of lipids and measurements of creatinina and enzymes of the liver. The measurement of the quantity of testosterone in the blood can give information about problems with the endocrine system and is especially indicated in patients with sexual desire diminished. Other tests

The monitoring of the erections that occur during the dream (tumescencia peniana nocturnal) can help to rule out certain psychological causes of that of. The healthy men have involuntary erections during the dream. If did not there were nocturnal erections, then is possible that that of having a not psychological and physical cause. Nevertheless, the tests of the nocturnal erections are not completely dependable. The scientists have not normalized such tests and they have not determined when should they be taken to obtain better results. Exam psicosocial

An exam psicosocial, that utilizes an interview and a questionnaire, reveals factors psicosociales. Also it can be interviewed the sexual couple of a man to determine the expectations and perceptions during the sexual relation.

How treats that of?

The majority of the doctors suggests that the processing be carried out of less to more invasive. It is considered first to reduce any medicine that have damaging secondary effects. For example, the medicines for the high arterial pressure function of different ways. If you think that a medicine particularly is causing problems with the erection, avísele to its doctor and consult if can test a different class from medicine for the arterial pressure.

If they are indicated, the modifications of the conduct are considered subsequently and the psicoterapia in select patients, you followed by medicines orally or injected locally, devices of empty, and devices established surgically. In rare cases, would be able to be considered the surgery in veins or arteries. Psicoterapia

Often the experts treat that of with psychological base using techniques that diminish the associated anxiety with the sexual relation. The couple of the patient can help with the techniques, that include the gradual development of the intimacy and the stimulation. Such techniques can also help to alleviate the anxiety when treats that of by physical causes.

Therapy with medicines

The medicines to treat that of can be taken for mouth, they can be injected directly in the penis, or to be inserted in the urethra by the tip of the penis. In March of 1998, the Administration of Food and Medicines approved Viagra, the first pill to try. It taken an hour before the sexual activity, Viagra functions enlarging the effects of the nitric oxide, a chemical agent that relaxes the smooth muscles of the penis during the sexual stimulation and permits an increase of the blood flow.

In spite of the fact that Viagra improvement the answer to the sexual stimulation, does not unchain an automatic erection as the injections do it. The dose recommended is of 50 mg, the doctor can adjust this dose to 100 mg or 25 mg, depending on the patient. The medicine should not be used more than one time al day. The men that take based on medicines nitrates such as the nitroglycerine for problems of the heart should not use Viagra since the combination can cause a sudden fall of the arterial pressure.

Is possible that soon have additional oral medicines to treat that of. They are being tested Vardenafil and Cialis by their security and efficacy. Both medicines function like the Viagra enlarging the blood flow toward the penis. A third medicine to test, Uprima, functions in the brain and the nervous system to unchain an erection.

The oral testosterone can reduce that of in some men with low levels of natural testosterone, but often is not efficient and can cause damage in the liver. The patients have also demanded that other oral medicines—that include the hydrochlorate of yohimbina, the agonistas of the dopamine and the serotonin, and trazodona—they are efficient, but the results of scientific studies that substancien these claims have been unstable. The improvements observed after the use of these medicines can be examples of the effect placebo, this is, a change that results simply because the patient creates that is going to occur an improvement.

Many men manage to have stronger erections being injected medicines in the penis, doing that is stuffed with blood. Medicines as the hydrochlorate of papaverina, fentolamina and alprostadil (marketed as Caverject) they widen the blood vessels. Nevertheless, these medicines can create secondary effects done not desire, that include a persistent erection (known as priapismo) and scars. The nitroglycerine, a relajante muscular, at times can enlarge an erection when rubs itself it on the penis.

A system to insert a granule of alprostadil in the urethra markets itself as Muse. The system uses an applicator prellenado to place the granule around an inch inside the urethra. Will begin an erection in 8 to 10 minutes and can last from 30 to 60 minutes. The most common secondary effects are pain in the penis, testicles and area among the penis and the straight one; sensation of heat or ardor in the urethra; reddening owed al increase of the blood flow toward the penis; and light bled or you stain uretrales.

The investigation of medicines to treat that of is being expanded quickly. The patients should consult with their doctor about the last advances.

Devices of empty

The devices of empty mechanics cause erection creating an empty partial one, that carries blood toward the penis, swelling it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a bomb, that extracts air out of the cylinder and an elastic band, that is placed around the base of the penis to maintain the erection after be withdrawn the cylinder and during the sexual relation avoiding that the blood flow of return al body (to see the figure 2).

A variation of the device of empty involves a sheath of semirigid rubber that is placed in the penis and remains there after the erection is achieved and during the sexual relation. Surgery

The surgery generally has one of three goals:

* to establish a device that can cause that the penis return erect

* to reconstruct the arteries to enlarge the flow of blood al grieve

* to block the veins that permit that the blood leave the weavings of the penis

The devices established, known like prosthesis, they can return the erection to many men with OF. The possible problems with the implants include mechanical break and infection, although the mechanical problems have diminished in recent years due to the technological advances.

The malleable implants generally consist of a pair of rods, that are inserted surgically in the cavernous bodies. The user adjusts by hand the position of the penis and therefore, the rods. The adjustment does not affect the wide or long of the penis.

The inflatable implants consist of a pair of cylinders, that are inserted surgically inside the penis and they can be expanded using liquid to pressure (to see the figure 3). Some pipes connect the cylinders to a deposit of liquid and to a bomb, also established surgically. The patient inflates the cylinders pressing a small bomb, located under the skin in the scrotum. The inflatable implants can expand something the long one and the wide one of the penis. Also they leave al penis in a more natural state when is not inflated.

The surgery to repair arteries can reduce that of caused by obstructions that block the blood flow. The better candidates for said surgery are young men with a discreet blockade of an artery due to a wound in the crutch or the fracture of the pelvis. The procedure is less successful in older men with a blockade extended.

The surgery in the veins to permit that the blood leave the penis generally implies the procedure opposed—intentional blockade. The blockade of the veins (ligature) can reduce the loss of blood that diminishes the inflexibility of the penis during the erection. Nevertheless, the experts have been questioned about the long-term efficacy of this procedure, and rarely time is done. [Up] Hopes through the investigation

The advances in supositorios, injectable medicines, implants and devices of empty have expanded the options for the men that seek processing for that of. These advances have also helped to enlarge the number of men that seek processing. The therapy with genes is being tested for OF in various centers, which can offer a lasting therapeutic focus for that of.

The National Institute of the Diabetes and Renal and Digestive Illnesses (NIDDK, acronyms in English) sponsors programs directed to understand the causes of the erectile dysfunction and to find processing to revert its effects. The Division NIDDK of Renal Illnesses, Urológicas and Hematológicas supported the investigators that developed Viagra and continues supporting the basic investigation of the mechanisms of the erection and the illnesses that deteriorate the normal function in the cell and molecular levels, including diabetes and high arterial pressure. [Up] Points to recall

* The erectile dysfunction (OF) is the incapacity repeatedly to achieve or to maintain an erection it sufficiently sign as to have a sexual relation.

* OF it affects from 15 to 30 million American men.

* OF has generally a physical cause.

* OF is treatable in all the ages.

* The processing includes psicoterapia, therapy with medicines, devices of empty and surgery.