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Internet websites selling herbal treatments for erectile dysfunction



The objective of the study was to investigate the safety and reliability of internet websites selling and providing medical information regarding herbal substitutes for Viagra. Using keywords 'Herbal' and 'Viagra', websites selling and providing medical information regarding herbal substitutes were identified. The top 50 sequential sites were assessed for safety and reliability against the Health on the Net (HON) criteria. Medically trained staff provided information in only 21% of the sites yet just 24% stated that the information was not a replacement for medical advice. No sites warned patients about erectile dysfunction (ED)-associated cardiovascular disease. In all, 88 and 70% of sites indicated drug efficacy and ingredients but only 36 and 21% provided contraindications and side effects, respectively. All sites fell short of the HON requirements. In conclusion, acquiring medical information and herbal substitutes for ED from the internet is convenient and easy. However, patients should be cautious as safety and reliability of this approach is poor.
Internet websites selling herbal treatments for erectile dysfunction
R Thurairaja
*, B Barrass
and R Persad
Department of Urology, Bristol Royal Infirmary, Bristol, UK
The objective of the study was to investigate the safety and reliability of internet websites selling and
providing medical information regarding herbal substitutes for Viagra. Using keywords ‘Herbal’
and ‘Viagra’, websites selling and providing medical information regarding herbal substitutes were
identified. The top 50 sequential sites were assessed for safety and reliability against the Health on
the Net (HON) criteria. Medically trained staff provided information in only 21% of the sites yet just
24% stated that the information was not a replacement for medical advice. No sites warned patients
about erectile dysfunction (ED)-associated cardiovascular disease. In all, 88 and 70% of sites
indicated drug efficacy and ingredients but only 36 and 21% provided contraindications and side
effects, respectively. All sites fell short of the HON requirements. In conclusion, acquiring medical
information and herbal substitutes for ED from the internet is convenient and easy. However,
patients should be cautious as safety and reliability of this approach is poor.
International Journal of Impotence Research (2005) 17, 196200. doi:10.1038/sj.ijir.3901282
Published online 28 October 2004
Keywords: herbal treatments; internet; erectile dysfunction
Erectile dysfunction (ED) is a common and distres-
sing condition affecting an increasing number of
It is estimated that almost 30 million men
in the US and two to three million men in the UK
suffer from ED.
According to the American Urolo-
gical Association clinical guidelines, ED is defined
as ‘the inability to achieve or maintain an erection
sufficient for satisfactory sexual intercourse’.
growing incidence of ED is related primarily to a
growing ageing population worldwide, a rise in the
prevalence of risk factors (such as diabetes and
cardiovascular disease) and an increase in treatment
for prostate cancer. Prostate cancer is now the most
commonly diagnosed cancer among Western men
and, ED is a common side effect of treatment.
Despite this, it is estimated that close to 90% of ED
sufferers are still reluctant to visit their family
doctors because of embarrassment.
the National Health and Social Life Survey (NHSLS)
concluded that although 31% of American men aged
18–59 y suffered sexual dysfunction, only 10% of
the men (or 3% of the men surveyed) sought medical
advice while the postsildenafil survey for the Pfizer
Global Study of Sexual Attitudes and Behaviours
found that only 19% of men reporting sexual
problems actively sought medical advice in the past
The internet is now one of the most readily
accessible and comprehensive methods for acces-
sing medical information and treatments by the
public. Studies have shown that more than half the
population of North America has access to the
internet and up to 62% of users were seeking health
or medical information.
Many websites address
health and medical issues in conjunction with the
sale of products that may alleviate health problems
and diseases, including prescription and nonpre-
scription drugs and health supplements. In the US,
from 1990 to 1997, there was a 380% increase in the
use of herbal remedies and in 2001 over half the
population of America were regularly taking herbal
Herbal treatments are health supplements that are
chemically rich in plant or plant parts containing
single or multiple ingredients in the form of tablets,
capsules, creams or tinctures.
Since Viagra (silde-
nafil) was first introduced as an effective tablet
treatment for ED by Pfizer in 1998, there has been a
rise in the sale of herbal substitutes of Viagra on the
Received 27 April 2004; revised 29 September 2004;
accepted 29 September 2004
*Correspondence: R Thurairaja, Department of Urology,
Bristol Royal Infirmary, Marlborough Street, Bristol BS2
8HW, UK.
International Journal of Impotence Research (2005) 17, 196200
2005 Nature Publishing Group All rights reserved 0955-9930/05 $30.00
Viagra is now well established as a brand
name, which the public associate with effective and
safe relief from erectile failure. Websites therefore
use the Viagra brand to promote their products and
may even advertise herbal treatments for ED as
‘Herbal Viagra’. Such websites frequently describe
their products as being efficacious, safe and contain-
ing only natural products with no side effects. The
internet therefore provides an easy and confidential
method obtaining nonprescription herbal treatments
for ED, which will be perceived as being both safe
and effective.
However, the safety of herbal treatments pur-
chased from the internet is unclear. In addition, the
quality and reliability of medical information pro-
vided by websites providing herbal treatments for
ED is unknown. A survey of internet sites selling
herbal supplements for ED was therefore conducted
in order to investigate their safety and reliability
against set criteria.
Materials and methods
In July 2003, an internet search using the key
words ‘Herbal’ and ‘Viagra’ was conducted with
the world’s largest internet search engine (www. The first 50 sites were identified and
sequentially investigated. Safety and reliability were
assessed against the validated and well-established
Code of Conduct (COC) requirements (Table 1)
provided by the Health on the Net (HON) Founda-
The HON Foundation is a medical and health
website accreditation body that is supported by the
World Health Organisation (WHO). It recommends
standards that websites providing medical and
health information should adhere to. Although there
are a number of professional and national criteria for
assessing the quality of medical information on the
internet, the HON criterion was identified as an
ideal tool for assessment since it has been used in
similar studies previously.
In addition, it was
noted whether sites provided specific advice regard-
ing the assessment of occult cardiovascular disease,
which is known to be associated with ED.
information provided by websites in terms of the
drugs they advertised (ingredients, efficacy, side
effects and contraindications) was also recorded.
A total of 160 000 websites were identified from the
search. Of the 50 sites reviewed, 33 were new and
independent sites, whereas the remaining 17 sites
were hyperlinks to one of the other 33 sites.
Medically trained personnel provided the infor-
mation in 21% of sites, 24% clearly stated that their
information was not to replace doctors’ advice, 18%
had referenced information and 33% provided
disclaimers (Figure 1). No sites specifically advised
Table 1 HON guidelines
Guidelines from HON code of conduct for medical and health websites
Principle 1—Authority
Any medical or health advice provided and hosted on this site will only be given by medically trained and qualified professionals
unless a clear statement is made that a piece of advice offered is from a nonmedically qualified individual or organization
Principle 2—Complementarity
The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and
his/her existing physician
Principle 3Confidentiality
Confidentiality of data relating to individual patients and visitors to a medical/health website, including their identity, is respected by
this website. The website owners undertake to honour or exceed the legal requirements of medical/health information privacy that apply
in the country and state where the website and mirror sites are located
Principle 4—Attribution
Where appropriate, information contained on this site will be supported by clear references to source data and, where possible, have
specific HTML links to that data. The data when a clinical page was last modified will be clearly displayed (eg, at the bottom of the page)
Principle 5Justifiability
Any claims relating to the benefits/performance of a specific treatment, commercial product or service will be supported by
appropriate, balanced evidence in the manner outlined in Principle 4
Principle 6Transparency of Authorship
The designers of this website will seek to provide information in the clearest possible manner and provide contact addresses for
visitors who seek further information or support. The Webmaster will display his/her E-mail address clearly throughout the website
Principle 7Transparency of Sponsorship
Support for this website will be clearly identified, including the identities of commercial and noncommercial organisations that have
contributed funding, services or material for the site
Principle 8Honesty in Advertising and Editorial Policy
If advertising is a source of funding, it will be clearly stated. A brief description of the advertising policy adopted by the website
owners will be displayed on the site. Advertising and other promotional material will be presented to viewers in a manner and context
that facilitate differentiation between it and the original material created by the institution operating the site
The eight HON criteria that websites providing medical and health information on the internet are recommended to fulfil.
Treatments for erectile dysfunction
R Thurairaja et al
International Journal of Impotence Research
patients with ED to seek assessment of occult
cardiovascular disease.
Of the sites reviewed, 88% outlined the effective-
ness of drugs and 70% stated drug ingredients.
However, only 36% provided contraindications
and 21% indicated drug side effects (Figure 2).
The commonest listed ingredients were yohimbine,
ginseng and gingko biloba.
In summary, all 33 new and independent sites
reviewed fell short of fulfilling the HON criteria and
the majority of sites provided inadequate informa-
tion regarding the side effects and contraindications
of the treatments they supplied.
As a result of the massive expansion in internet use
during the last decade, health information is now
readily available to the public and the number of
websites providing medical advice or selling treat-
ments is steadily rising.
However, studies have
demonstrated that, without any regulations, the
quality of health-related websites varies consider-
ably and frequently falls short of conventional
medical advice.
For example, Impicciatore
demonstrated the information provided by websites
concerning the management of fever in children to
be highly inconsistent.
When Eysenbach reviewed
79 studies evaluating the quality of health informa-
tion provided by internet websites, it was concluded
that the information quality was equivocal.
Although regulatory bodies such as HON exist to
assess and accredit the quality of medical and
health-related websites, most sites choose not to be
Despite significant advances in the pharmacolo-
gical treatment of ED in recent years, there is still a
growing interest and demand for herbal treatments
for ED.
This may be attributed to the easy purchase
of nonprescription products and the lower costs
compared to some prescription drugs. The internet
provides an easy and confidential method of
acquiring health information and treatments for
ED. However, there are many uncertainties with
respect to the quality of health information as
described above and the efficacy and safety of these
products is not well established. In the present
study, less than a quarter of sites clearly stated that
their information was provided by medically trained
personnel or provided referenced information. Most
of these sites produced anecdotal evidence and third
party testimonials instead of scientific data to
support their products.
Most sites (88%) made claims about the effective-
ness of their products in treating ED but almost a
Sites with
provided by
Medically Trained
Sites with
Sites warning to
seek Medical
Sites with
Sites fulfilling HON criteria (% total)
Figure 1 Details of site information. Percentage of websites
reviewed that fulfilled four specific guidelines from HON criteria
(authority, attribution, complementarity and disclaimers).
Drug Side-
Drug Contra-
Sites providing drug Information (% total number sites)
Figure 2 Details of drug information. Percentage of websites
reviewed that described the herbal treatment being sold in terms
of efficacy, ingredients, side effects and contraindications.
Treatments for erectile dysfunction
R Thurairaja et al
International Journal of Impotence Research
third (30%) failed to clearly state the ingredients
making up the treatments. This has concerning
implications since it has previously been reported
that treatments marketed as entirely natural dietary
supplements have subsequently been found to
contain significant levels of active pharmaceutical
compounds. For example, in April 2003, in the
United States, the Food and Drug Administration
(FDA) discovered that tablets marketed as all-natural
herbal products to enhance sexual experience for
men and women (Vinarol) contained a type-5
phosphodiesterase (PDE5) inhibitor (sildenafil).
Likewise in Canada, the Chinese herbal preparation
‘Hua Fo’ was also found to contain a compound
similar to sildenafil.
Patients taking these prepara-
tions would unwittingly be putting themselves at
risk from the potentially dangerous adverse effects
of a prescription-only PDE5 inhibitor (such as life-
threatening hypotension if taken concurrently with
nitrates). For this reason, Vinarol and ‘Hua Fo’ were
subsequently recalled. However, it is unknown how
many other treatments for ED marketed as ‘Herbal’
supplements actually contain active and potentially
dangerous compounds.
There are limited data from randomised con-
trolled trials to support efficacy and safety of the
commonest stated ingredients in the herbal treat-
ments identified in this study (yohimbine, ginseng
and Gingko biloba) for the treatment of ED. However,
despite the fact that only 21 and 36% of websites
investigated provided side effects and contraindica-
tions for their treatments, respectively, yohimbine,
ginseng and Gingko biloba have all been reported to
have clinically significant adverse effects and con-
For example, yohimbine, a herb derived from a
tree native to Africa, has been shown to improve
male erections, but is contraindicated in patients
with cardiovascular and neurological disease and
causes several side effects including headaches,
sweating and hypertension.
These cardiac ef-
fects are likely to have particularly important
implications, given the high prevalence of cardio-
vascular disease in men with ED.
To date, most
studies investigating the efficacy of ginseng in the
treatment of ED have been performed in animals
where it has been shown to relax cavernosal smooth
muscle in rabbits and decrease time to ejaculation in
Recently, two clinical studies have demon-
strated ginseng’s effectiveness in improving para-
meters of erectile function such as penile rigidity
and duration of erection.
Documented adverse
effects of ginseng include gastrointestinal distur-
bances and dermatitis, and it is contraindicated in
patients with acute inflammatory disease and
Gingko biloba has been shown to relax
vascular smooth muscle and this mechanism of
action is thought to contribute to an improvement in
However, a number of side effects including
diarrhoea, vomiting, headaches and allergic skin
reactions following consumption of Gingko biloba
have been reported.
It is also concerning that
Gingko biloba can potentiate the action of anti-
coagulants such as aspirin or warfarin to cause
bleeding disorders.
It is therefore contraindicated
in patients receiving anticoagulants to treat cardio-
vascular and cerebrovascular disorders.
Less than a quarter (24%) of the sites reviewed in
this study encouraged patients to seek medical
advice. ED is known to be associated with general-
ised disease in the vascular endothelium and the
onset of ED may be the first presentation of treatable
but potentially life-threatening cardiovascular dis-
By self-treating ED with herbal products
purchased from the internet, occult ED-associated
cardiovascular disease would go undiagnosed and
untreated, which could result in irreversible com-
plications and even death.
In conclusion, acquiring medical information
regarding ED and purchasing treatments such as
‘Herbal Viagra’ from the internet is convenient and
easy; however, the safety and reliability of such
websites and treatments is poor. Occult ED-asso-
ciated cardiovascular disease will go undiagnosed
and untreated among patients using this approach
and patients taking herbal treatments without
knowing their composition and effects are at risk
from potentially harmful adverse effects. Until more
stringent regulations are implemented, patients
should be cautious when acquiring information
and ‘Herbal’ treatment for ED from the internet.
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... Of these, approximately 83% report using the Internet to look for health-related information, including for dietary supplements. 20 By building on the body of published literature regarding Internet sources of information for herbal products, [16][17][18][19][21][22][23][24] the objective of the current study was to examine the state of online information with respect to top-selling herbal products, now a decade after the last large systematic review. 16 By using online searches that are typical of today's consumer for herbal products and herbal product information, we conducted the largest Internet search of herbal products to date and included the 10 most commonly used herbal products, as well as 3 additional top-selling herbals with known safety concerns. ...
Herbal products are commonly used to treat clinical conditions and are often purchased online without the supervision of a healthcare provider. The use of herbals remains controversial because of widespread exaggerated claims of clinical efficacy and safety. We conducted an online search of 13 common herbals (including black cohosh, echinacea, garlic, ginkgo, ginseng, green tea, kava, saw palmetto, and St John's wort) and reviewed the top 50 Web sites for each using a Google search. We analyzed clinical claims, warnings, and other safety information. A total of 1179 Web sites were examined. Less than 8% of retail sites provided information regarding potential adverse effects, drug interactions, and other safety information; only 10.5% recommended consultation with a healthcare professional. Less than 3% cited scientific literature to accompany their claims. Key safety information is still lacking from many online sources of herbal information. Certain nonretail site types may be more reliable, but physicians and other healthcare professionals should be aware of the variable quality of these sites to help patients make more informed decisions.
... Over recent years, the use of complementary and alternative medicines has become increasingly popular [15], and ED is one condition for which herbal supplements are heavily promoted and easily accessible [16]. ED sufferers often seek alternatives, since many are reticent to express their sexual problems to physicians [17], or are dissatisfied with current therapies. ...
Full-text available
Background: Evidence is lacking for multi-ingredient herbal supplements claiming therapeutic effect in sexual dysfunction in men. We examined the safety and efficacy of VigRX Plus (VXP) - a proprietary polyherbal preparation for improving male sexual function, in a double blind, randomized placebo-controlled, parallel groups, multi-centre study. Methods: 78 men aged 25-50 years of age; suffering from mild to moderate erectile dysfunction (ED), participated in this study. Subjects were randomized to receive VXP or placebo at a dose of two capsules twice daily for 12 weeks. The international index of erectile function (IIEF) was the primary outcome measure of efficacy. Other efficacy measures were: Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), Serum testosterone, Semen analysis, Investigator's Global assessment and Subjects' opinion. Results: In subjects receiving VXP, the IIEF-Erectile Function (EF) scores improved significantly as compared to placebo. After 12 weeks of treatment, the mean (sd) IIEF-EF score at baseline increased from 16.08 (2.87) to 25.08 (4.56) in the VXP group versus 15.86 (3.24) to 16.47 (4.25) in the placebo group (P < 0.0001). Similar results were observed in each of the remaining four domains of the IIEF (orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction).There was a significant difference for VXP versus placebo comparison of mean (sd) EDITS scores of patients: 82.31(20.23) vs 36.78(22.53) and partners :(82.75(9.8) vs 18.50(9.44);P < 0.001. Thirty-five out of 39 (90%) subjects from the VXP group and one (3%) from the placebo group wished to continue with the treatment they received. Investigator's global assessment rated VXP therapy as very good to excellent in more than 50% patients and placebo therapy as fair to good in about 25% of patients. Incidence of side effects and subject's rating for tolerability of treatment was similar in both groups. Conclusions: VigRX Plus was well tolerated and more effective than placebo in improving sexual function in men. Trial registration: Clinical Trial Registry India, CTRI/2009/091/000099, 31-03-2009.
... Cette étude a montré le non respect des principes du HONcode en dehors d'un processus de certification [10]. D'autres études ont montré le faible respect des principes du HONcode [11][12][13][14][15]. ...
The 2004 statute that created the French National Authority for Health (HAS, Haute Autorité de Santé) required it to establish a procedure for the certification of health-related web sites. The HAS established a procedure based on the HONcode certification scheme set up by the Health On the Net Foundation, with which HAS has a partnership agreement. The HONcode includes eight principles that govern the quality of online heath information and its presentation (quality of the production process). The collaboration between HAS and HON has already led to improvements in a large number of web sites in France and to their certification. The main advantages of certification for site publishers are better site quality and enhanced credibility rather than a larger audience. Quality certification has little impact on the choice of site by Internet users as they tend to use search engines to find health-related information. Future development of the procedure should work to increase the value of certification both by improving the quality of sites and in signaling quality to Internet users.
In this chapter we explore sexuality and how it is affected by various medical illnesses and psychological disturbances. We review the physical effects of illnesses on males and females and discuss how sexuality is affected by such emotional conditions as depression and anxiety.
Conference Paper
Full-text available
Medical informatics presents a wide array of resources to health care providers to improve many aspects of their professional activity. Central to this issue, the Internet can be considered as a valuable instrument in supporting evidence based medicine and improving health care services, by facilitating efficient, rapid, and convenient access to continuing medical education. Moreover, e-health could well become a major element in facilitating the diffusion of scientific knowledge, new methods of assistance and cure, and the promotion of effective policy for the development of sanitary systems in the international context.
A survey of herbal medicines available for internet and over-the-counter purchase in South Australia, Australia, was conducted looking specifically at those used for ‘arthritis’, ‘cold and flu’, ‘gastrointestinal’, ‘stress’ and ‘premenstrual syndrome’. 121 products consisted of 29 in the ‘arthritis’ category, 33 in ‘cold and flu’, 19 in ‘gastrointestinal’’ 30 in ‘stress’ and 10 in ‘premenstrual syndrome’. Twenty two (18%) of 121 products were not registered with the Australian Register of Therapeutic Goods (ARTG), despite this being a legal requirement for their sale. Of the registered products 59 (60%) of 99 had differing ingredient concentrations on the website compared to their ARTG listing. Only three of the 15 purchased products had ingredient concentrations which were consistent between the website, ARTG listing and product packaging. These findings demonstrate that it may not be possible to determine what herbal substance an individual has been exposed to prior to death and in what concentration, based on packaging from medications seized at the scene, or from examination of website data and the ARTG listing. These discrepancies may increase the problems that exist in attempting to determine what role herbal medicines may play in the mechanism of death in certain forensic cases.
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The objectives of this study aim to show that the HONcode developed by the Health-on-the-Net Foundation improves the transparency of the health information found on the Internet. In a comparative study, the compliance by health websites to the HONcode by certified websites were compared with uncertified French health websites which never applied for the certification. We compared the compliance with the 8 HONcode principles, and respectively the respect of principles 1, 4, 5 and 8 by the certified websites and by the uncertified websites. The assessment of the HONcode compliance was performed by HON evaluators by the same standards for all type of sites. This analysis shows that these health websites do not respect spontaneously the HONcode principles. It is the certification process that led them to respect those principles which lasted at least until the 6 th -8 th month after obtaining the certification.
This study aims to show that health websites not asking for HONcode certification (Control sample websites A) do not respect elementary ethical standards such as the HONcode. The HONcode quality and ethical standards and the certification process have been developed by the Health on the Net Foundation to improve the transparency of the health and medical information found on the Internet. We compared the compliance with the 8 HONcode principles, and respectively the respect of principles 1 (authority), 4 (assignment), 5 (justification) and 8 (honesty in advertising and editorial policy) by certified websites (A) and by health websites which have not requested the certification (B). The assessment of the HONcode compliance was performed by HON evaluators by the same standards for all type of sites. Results shows that 0.6% of health websites not asking for HONcode certification does respect the eight HONcode ethical standards vs. 89% of certified websites. Regarding the principles 1, 4, 5 and 8, 1.2% of B respect these principles vs. 92% for A. The certification process led health websites to respect the ethical and quality standards such as the HONcode, and disclosing the production process of the health website.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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The extracts of Korean red ginseng (EKG) is a complex mixture containing ginsenosides, polysaccharides, and several other products. Animal experiments have shown that the intravenous administration of extract of ginseng reduces blood pressure. Recently, it has been reported that ginseng has a relaxing effect on vascular smooth muscle and that the relaxation is associated with nitric oxide (NO) released from the vascular endothelium. The present study was undertaken to investigate the effects of EKG on isolated rabbit corpus cavernosal smooth muscle for evaluation of the possibility of developing EKG as an pharmacoerecting agent. Strips of rabbit corpus cavernosum were mounted in organ chambers to measure isometric tension. On the precontracted muscle strip with phenylephrine (PHE; 5 x 10(-6) M), EKG began to exert a relaxing effect at the concentration of 1 mg/ml and the maximal relaxation effect was reached at 40 mg/ml in a dose-dependent manner. EKG was inhibited significantly by endothelial disruption and by pretreatment with methylene blue, pyrogallol, L-NNA or atropine. EKG partially inhibited the PHE (5 x 10(-6) M) induced contraction up to 45.67% of the control in a dose-dependent fashion. EKG decreased basal tension as well as inhibited the contraction induced by addition of CaCl2 (10(-3) M) dose-dependently in muscle strips at basal equilibrated state in Ca2+ free, high K+ depolarizing solution. EKG also inhibited the contraction induced by depolarization with 20, 40 and 60 mM of KCl. However, this inhibitory effect did not occur with high concentrations of KCl (80 and 120 mM). EKG has a relaxing effect on the rabbit corpus cavernosal tissue in a dose dependent manner. The relaxation action of EKG is mediated by multiple action mechanisms that include increasing the release of NO from the corporal sinusoids, increasing intracellular calcium sequestration, and a hyperpolarizing action.
Objective: To evaluate the quality of patient information about emergency contraception on the Internet. Design: We performed an on-line search of the Internet and found relevant World Wide Web sites by combining the key phrases 'emergency contraception' and 'patient information' in two Web subject guides and two search engines. We defined quality as the extent to which the characteristics of a Web site satisfied its stated and implied objectives. Our assessment focused on credibility and content of each Web site. Credibility was assessed by source, currency and editorial review process and content of Web site was assessed by hierarchy and accuracy of evidence. Results: Our search revealed 32 relevant Web sites, none of which complied with all of the criteria for quality of credibility and content. Twenty-eight Web sites displayed the source clearly, 17 Web sites showed currency, and none of the Web sites had an editorial review process. Only six of the 32 sites mentioned hierarchy of evidence. None of the Web sites depicted all the criteria for accuracy of contents. Conclusion: None of the Web sites provided complete information to patients about emergency contraception according to the quality criteria used in this study. As previous studies have shown, people need to be wary about the quality of information on the Internet.
Misuse of prescription medications is a serious problem largely due to lack of information. Lay users are making use of resources available on the World Wide Web in order to bridge this information gap. It has already been noted though that health and medicine oriented sites present serious shortcomings with regard to quality and reliability of their content. In this review, checklists were used to determine to which extent the criteria suggested for quality evaluation of on-line health information are observed by sites offering information on R x medications to the public. Also evaluated was the sites' comprehensiveness in coverage of important subject specific topics. The reviewed sites met inadequately the proposed quality criteria and presented significant variations in their coverage of the subject. Evaluation of information accuracy remains an unresolved problem in quality assessment, while techniques for automated review and retrieval are urgently needed. In the meantime, though, quality guidelines...
Erectile dysfunction (ED) is an increasingly common problem, affecting up to 30 million American men. This largely results from increased risk factors and an aging population. ED is now also recognized as a marker for cardiovascular disease. The ED patient should be thoroughly evaluated for coexisting vascular disease. The pathophysiology of ED is becoming better understood, largely as a result of the development of new therapies. Once the underlying processes are known, more selective targeting of these will lead to novel “designer drugs.”
To assess the quality of information on the Internet regarding Plan B, the Yuzpe method, and the copper intrauterine device (IUD). An Internet search was performed using 4 common search engines with the terms morning after pill, emergency contraception, and Plan B. The first 20 websites generated by each search were evaluated. Websites were excluded if they were not informational sites. Descriptive analysis was performed. Fifty-one websites were unique and relevant to the study criteria. The majority of sites reported that Plan B should be taken within 72 hours of unprotected intercourse (92.2%) and could be obtained without a prescription (54.4%). The Yuzpe method and the copper IUD were less likely to be mentioned, though the information presented tended to be accurate. The majority of information regarding emergency contraception on the Internet is accurate, suggesting that the Internet could be used to increase emergency contraceptive knowledge for patients.
Yohimbine is an alkaloid derived mainly from the bark of the African tree, Pausinystalia yohimbe. Although many pharmacological properties of yohimbine have been described, at the plasma concentration attained at recommended dosages in man the predominant activity is antagonism of alpha 2-adrenoceptors. For more than 70 years yohimbine has been used as a treatment for male and female sexual difficulties. It has enjoyed a reputation as an aphrodisiac although no effect on sexual drive in humans has been adequately demonstrated. Yohimbine has been evaluated in the management of erectile disorder by means of placebo-controlled but often poorly designed trials. It does appear to have a modest therapeutic benefit over placebo, particularly in essentially psychogenic erectile disorder, and is generally well tolerated. Yohimbine is not licensed in the UK.
We provide current, normative data on the prevalence of impotence, and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study. The Massachusetts Male Aging Study was a community based, random sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject's home. A self-administered sexual activity questionnaire was used to characterize erectile potency. The combined prevalence of minimal, moderate and complete impotence was 52%. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. Subject age was the variable most strongly associated with impotence. After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension. We conclude that impotence is a major health concern in light of the high prevalence, is strongly associated with age, has multiple determinants, including some risk factors for vascular disease, and may be due partly to modifiable para-aging phenomena.