Will we ever be able to produce something capable of making us reach the optimum of one of humankind's most basic needs? Will there always be a side effect? Since the beginnings of civilization, people have been obsessed about their sexuality. Men and women have always tried to achieve a maximum amount of pleasure in any possible way. For human beings this is obtained through the orgasm. Humans usually attain this is goal through sexual intercourse or masturbation.

However, sometimes the psychological and physical conditions of a person can deprive him or her from reaching that goal. Thankfully, science and anatomy have also always interested mankind. This has helped to find solutions for problems dealing with our sexuality, which, as a matter of fact are very common. The most recurrent and drastic of all these dilemmas is that of impotence.

The term 'impotence' has traditionally been used to signify the inability of the male to attain and maintain erection of the penis sufficient to permit satisfactory sexual intercourse. However, this use has often led to confusing and uninterpretable results in both clinical and basic science investigations. This, together with its pejorative implications, suggests that the more precise term 'erectile dysfunction' be used instead to signify an inability of the male to achieve an erect penis as part of the overall multifaceted process of male sexual function. Erectile dysfunction affects millions of men.

Although for some men erectile function may not be the best or most important measure of sexual satisfaction, for many men erectile dysfunction creates mental stress that affects their interactions with family and associates. All these things might be very interesting, but to fully understand erectile dysfunction we must first take a look into the physiology of the male erection. In its most common form, the male erectile response is initiated by a central nervous system event that integrates psychogenic stimuli (perception, desire, etc.) and controls the sympathetic and parasympathetic innervation of the penis. Parasympathetic input allows an erection by relaxation of trabecular smooth muscle and dilation of the helicline arteries of the penis. This fills the spongy tissue that forms the penis with blood; a process referred to as the corporal ve no occlusive mechanism. The erectile tissues must have sufficient stiffness to compress the blood vessels penetrating it so that venous outflow is blocked and sufficient tumescence and rigidity can occur.

Constriction of the trabecular smooth muscle and helicline arteries induced by sympathetic innervation makes the penis flaccid, with blood pressure in the sinuses of the penis near venous pressure. When the trabecular smooth muscle relaxes and helicline arteries dilate in response to parasympathetic stimulation and decreased sympathetic tone, increased blood flow fills the cavernous spaces, increasing the pressure within these spaces so that the penis becomes erect. As the venules are compressed against the tunica, penile pressure approaches arterial pressure, causing rigidity. Once this state is achieved, arterial inflow is reduced to a level that matches venous outflow.

After the orgasm, during the resolution, the erection is lost rapidly and the man enters a refractory period where re arousal can be quite difficult for a time. Now that the basic functioning of the male erection has been explained we can go on with the subject of this essay. Because adequate arterial supply is critical for erection, any disorder that impairs blood flow may be implicated in erectile failure. Most of the medical disorders associated with erectile dysfunction appear to affect the arterial system. Some disorders may interfere with the corporal ve no occlusive mechanism and result in failure to trap blood within the penis, or produce leakage such that an erection cannot be maintained or is easily lost. Lesions of the somatic nervous pathways may impair erections and may interrupt tactile sensation needed to maintain psychogenic erections.

Spinal cord lesions may produce varying degrees of erectile failure depending on the location and completeness of the lesions. Not only do traumatic lesions affect erectile ability, but disorders leading to peripheral neuropathy may also impair neuronal innervation of the penis or of the sensory afferent's. The endocrine system itself, particularly the production of androgen's, appears to play a role in regulating sexual interest, and may also play a role in erectile function. Psychological processes such as depression, anxiety, and relationship problems can impair erectile functioning by reducing erotic focus or otherwise reducing awareness of sensory experience. This may lead to inability to initiate or maintain an erection. Erectile dysfunction is clearly a symptom of many conditions, and certain risk factors have been identified, some of which may be amenable to prevention strategies.

Diabetes, in association with a number of endocrinologic conditions, hypertension, vascular disease, high levels of blood cholesterol, low levels of high density lipoprotein, drugs and neurogenic disorders have al! been demonstrated as risk factors. Others in the list are Peyronie's disease, priapism, depression, alcohol ingestion, lack of sexual knowledge, poor sexual techniques, inadequate interpersonal relationships or their deterioration, and many chronic diseases and especially renal failure and dialysis. Vascular surgery is also often a risk factor. Age appears to be a strong indirect risk factor in that! t is associated with an increased likelihood of direct risk factors. Smoking also has an adverse effect ok erectile function by accentuating the effects of other risk factors such as vascular disease or hypertension. To date, vasectomy has not been associated with an increased risk of erectile dysfunction other than causing an occasional psychological reaction that could then have a psychogenic influence.

Accurate risk factor identification and characterization are essential for concerted efforts at prevention of erectile dysfunction. Thankfully, prevention is not the only solution. There are many different and effective methods of fighting erectile dysfunction. Some of these are psychotherapy and behavioral therapy, medical therapy, injection therapy, vacuum / constrictive devices, vascular surgery and penile prostheses. These are the most common methods among modern occidental medicine, but there are many others techniques and medicines against impotence that have been and are still being used in oriental medicine. These are not usually taken seriously since it is often thought of as an inefficient science.

An example is Ginseng, which is apparently effective and without dangerous or Unpleasant side effects. Even though effective, these ways of fighting or preventing erectile dysfunction are cumbersome, painful or inefficient. However, this problem has apparently been eradicated with the invention of a miraculous little pill. The name of this new blue 'friend' of al! men with erectile dysfunction is VIAGRA. Sildenafil citrate is a white to off-white crystalline powder with a solubility of 3.5 mg / m L in water and a molecular weight of 666.7.

VIAGRA (citrate) is formulated as blue, film-coated rounded-diamond-shaped tablets equivalent to 25 mg, 50 mg and 100 mg of for oral administration. In addition to the active ingredient, citrate, each tablet contains the following inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, sodium, magnesium, methyl cellulose, titanium dioxide, lactose, , and FD & C Blue #2 aluminum lake. The physiologic mechanism of erection of the penis involves release of nitric...