Erectile dysfunction, sometimes called "impotence," is the
repeated inability to get or keep an erection firm enough for
sexual intercourse. The word "impotence" may also be used to
describe other problems that interfere with sexual intercourse and
reproduction, such as lack of sexual desire and problems with
ejaculation or orgasm. Using the term erectile dysfunction makes it
clear that those other problems are not involved.
Erectile dysfunction, or ED, can be a total inability to achieve
erection, an inconsistent ability to do so, or a tendency to
sustain only brief erections. These variations make defining ED and
estimating its incidence difficult. Estimates range from 15 million
to 30 million, depending on the definition used. According to the
National Ambulatory Medical Care Survey (NAMCS), for every 1,000
men in the United States, 7.7 physician office visits were made for
ED in 1985. By 1999, that rate had nearly tripled to 22.3. The
increase happened gradually, presumably as tre...
Driving a car to the local mechanic to get it fixed is not the same thing as taking the human body into surgery; although, this "fix-it" attitude drives patients and surgeons alike towards surgical solutions. Lately, a growing number of people are undergoing low back surgery . A recent study examined the relationship between patient expectations and the actual outcomes from lumbar spine surgery. Because pre-surgical expectations do not always equate to the actual results, how can a person judge whether or not a surgery was successful? How can one predict surgical success?
Understanding the primary reasons for seeking surgical solutions is the first step towards discussing the likelihood of success. The top three causes for patients wanting lumbar surgery are: 1#, other therapies have failed to help; 2#, the pain is unbearable; 3#, walking has become difficult. Based on these reasons to see a surgeon, patients come to the operating room harboring certain expectations. Patients wa...
Last month, the American Pain Society added to its recommendations to health care providers regarding the diagnosis and treatment of low back pain .
In addition, the Society decided to discuss openly procedures that could be risky to sufferers of low back pain, including recommendations on surgery and other invasive therapies.
Unfortunately, there is not a significant body of good evidence to justify unquestioningly embracing these new recommendations. It is difficult to find well-done clinical studies which support the use of a number of the more invasive treatments used for chronic low back pain.
The initial set of guidelines for the management of chronic low back pain were published in "Annals of Internal Medicine" last October. However, these recommendations dealt more with the initial evaluation of a low back pain patient, and included thoughts on what type of x-rays to order in addition to more conservative treatments such as massage/manipulation and exerci...
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