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"It's perfectly OK for a woman to say, 'Until we can find an answer to our problem, I want us to stay in touch physically and intimately,' and then seek his suggestions for how to do that," says Foley.
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"Having an erection does not mean you are being sexual. Being sexual comes from inside your sense of yourself," Shaw says. "You can be sexual, you can feel sexual, you can behave sexually without an erection. A penis is not the only part of a man's body that can be used sexually."
Address correspondence to Anthony J. Viera, LT, MC, USNR, Family Practice Department, PSC 490, Box 9097, U.S. Naval Hospital, Guam, FPO AP 96538-1600. Reprints are not available from the authors.
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By Steven Reinberg
In addition to healthy blood circulation, the male sex hormone testosterone is important for erections and for sex drive. Men with erectile dysfunction may have low testosterone levels.
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Intracavernosal administration of alprostadil (Caverject) has reported success rates of 67 to 85 percent and has been used in the treatment of erectile dysfunction for several years.11 When injected directly into the corpus cavernosum, alprostadil (prostaglandin E1) acts on the arteriolar smooth muscle cells, causing them to relax and produce an erection, usually within several minutes. Its mechanism of action is to stimulate an increase in the levels of intracellular cyclic nucleotides that cause relaxation. The usual dose is between 5 and 40 µg per injection. The current average wholesale price ranges from about $86 for six of the 5-mg doses to approximately $163 for six of the 40-µg doses.12 Patients usually start at 2.5 µg and titrate up in 5-µg increments for effect, with a maximum dose of 60 µg. No more than three injections per week are recommended, with a minimum period of 24 hours between injections.13 Initial dosing and required adjustments should be carried out in the physician's office.
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For any medication to be effective, the physiologic components involved in the erectile process must be functional. Serious impairments render the medication either completely or partially ineffective.
The American College of Obstetricians and Gynecologists (ACOG) reassures that the birth control pill is safe and effective for most women. However, although today's pills have lower doses of hormones than pills from previous decades, they still cause side effects, and some are quite serious.
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