The Pathophysiology and Therapy of Erectile Dysfunction in a Newly Discovered Treatise by Wolfgang Reichart (1486-circa 1547).

BACKGROUND: A newly-found treatise by Wolfgang Reichart (1486-circa 1547), town physician of Ulm, challenges the contemporary view that bewitchment as a cause of impotence defies any natural explanation. OBJECTIVE: To understand the pathophysiological concept and therapy of erectile dysfunction in Reichart's treatise by examination of his sources and previous concepts. METHODS: Source analysis of Reichart's treatise by comparison of the pathophysiological concepts and therapy of erectile dysfunction with original texts of the Corpus Hippocraticum (5th-3rd century BC) and Constantinus Africanus (11th century). RESULTS: By using rational thinking and medical knowledge mainly drawn from antiquity, especially Constantinus Africanus, Reichart shows that a supposed supernatural cause for impotence can be explained by reason and natural means. Reichart's treatise changes the view of bewitchment as cause of impotence. He makes eclectical use of previous concepts to explain his patient's condition. From the Middle Ages on, bewitchment was accepted as a cause for erectile dysfunction. Usually, physicians of that time accepted this etiology and advised a treatment based on theological concepts. Reichart challenges this view by emphasizing reason and medical knowledge as crucial for treating the patient, rejecting supernatural treatment approaches. CONCLUSIONS: In the 16th century, a type of rational thinking and medical knowledge emerges, which puts supernatural explanations into question and aims at treating patients with natural means. The analysis of Reichart's treatise is a much-needed contribution to understanding the historic development of pathophysiological concepts of and therapeutic measures for impotence, which is yet underresearched.

A Surgeon's Guide to the Various Antibiotic Dips Available During Penile Prosthesis Implantation.

PURPOSE OF REVIEW: Inflatable penile prosthesis (IPP) is a treatment for erectile dysfunction. IPPs have undergone improvements; however, post-surgical infections still occur. Furthermore, the type of pathogens infecting the implants has changed recently from Gram-positive to Gram-negative bacteria and fungi due to advances in antibiotic dips targeting the skin flora. To protect against infection, the AMS 700 is pre-coated with InhibiZone (mixture of Rifampin/Minocycline) and the Coloplast Titan, with several antibiotic dip options of differing efficacies. This review discusses strategies to decrease the infection rates in implant surgery, focusing on antibiotic dips. RECENT FINDINGS: Current research endorses the use of rifampin/gentamicin as the most studied combination; however, some studies have utilized different dips for additional coverage including the InhibiZone on the AMS 700. With the increasing prevalence of diabetes and Gram-negative organisms, there is a need to develop strategies for increased coverage against infections. Controlled studies with different antibiotic combinations are needed to identify the ideal cocktail to decrease infection.

Leaky Bodies, Bawdy Books: Gonorrhea and Reading in Eighteenth-Century Britain.

In eighteenth-century Britain, reading lewd books was understood to exacerbate gonorrhea. That pathology corresponded to a specific physiological model, which historians describe as the leaky male body. This article demonstrates how the connection between reading and gonorrhea correlated to three phenomena: 1) the neuro-sexual economy of bodily fluids; 2) the effects of reading on the sensible mind and body; and 3) the crossover of erotic and medical literatures. Aware of the physiological power of imagination, authors intentionally wrote to elicit strong physiological and sexual responses in readers. Concerns about the pathological and moral consequences of reading provocative material similarly informed criticisms of both the outright pornographic and the ostensibly medical. Partly in response to such criticisms, medical authors developed a more careful, decorous, and objective tone for writing about sexual topics. Ultimately, the culture of sensibility receded, as did anxieties about involuntary leaks of bodily fluids caused by reading.

[Sant'Ippazio (St. Hypatius of Gangra): A southern Italian cult of virility and red carrots]. / Sant'Ippazio (St. Hypatius von Gangra) : Ein süditalienischer Kult um Potenz und Pastinaken.

Sant'Ippazio (St. Hypatius of Gangra) is a saint, martyr, and advocate in cases of impotency, inguinal hernia, and other abdominal disorders. In Tiggiano, a small town at the southernmost point of Italy, Sant'Ippazio, bishop of Gangra, is venerated as a patron saint. According to legend, during an excited dispute on the question of the Arian heresy at the synod of Nicaea (325 AD), Bishop Ippazio was kicked in the lower abdominal region by an Arian presbyter, which caused an inguinal hernia. Therefore, his help is sought for relief and cure of hernia or impotency. Every January 19th, the day of the parish fair, particular carrots (the "pastinache") which have a reddish to violet color are sold. They are said to be similar to the saint's penis after the kick. Also described in this article are other pagan fertility rituals which have been christianized by the veneration of a saint and which are still kept alive among local populations.

Sleep-related erections throughout the ages.

INTRODUCTION: The occurrence of sleep-related erections (SREs) has been known since antiquity. AIM: To highlight historical, theological, and sexual medicine-related aspects of SREs throughout the ages. METHODS: Review of old medical books on male sexual functioning and review of scientific medical and theological articles on SREs from about 1900 on. RESULTS: The cyclic character of SREs was first noted by German researchers in the forties of the 20th century. However, already before the beginning of the Christian era, one knew that men had erections and ejaculations during sleep. In the Middle Ages, SREs were generally considered to be rebellious manifestations of the male body, while it seemed to disobey its owner and showed up its perverted and sinful side. From the fifteenth to the end of the 17th century, severe erectile dysfunction (ED) was ground for divorce. The ecclesiastical court records show that if necessary, the members of the jury sat at the defendant's bedside at night to be able to judge any SREs occurring. Since the 17th century, SREs were considered to be part of masturbation, which could cause many ailments and diseases. Psychoanalyst Stekel acknowledged in 1920 that a morning erection, the last SRE, is a naturally occurring phenomenon in healthy men from infancy to old age. Today, some scientists assume that SREs protect the integrity of the penile cavernous bodies. CONCLUSIONS: Throughout the ages, philosophers, theologians, physicians, members of ecclesial law courts, psychoanalysts, psychiatrists, sexologists, physiologists, and urologists have shown interest in SREs. Obviously, the observations and testing of SREs have a long history, from antiquity to modern sleep labs, in men and in women, in newborns and old adults, by penis rings with sharp spikes to fancy strain gauge devices. Despite all these efforts, the mechanisms leading to SREs and its function are however not yet completely understood.

La Medicina Sexual en la Historia. Avances y controversias (Parte II) / Sexual Medicine beyond History. Advances and controversies (Part II)

El recorrido histórico de la Medicina Sexual y la Andrología por los 2 últimos siglos permite ver cómo el desarrollo científico se ha acelerado hasta un nivel que hubiera parecido imposible a nuestros predecesores. A ello han contribuido en gran parte los logros en la comprensión de la fisiología y, desde luego, la cirugía, con el descubrimiento de la anestesia y el control de las infecciones y la hemostasia, pero, sin duda, también han sido parte importante en esta historia la nueva mentalidad de trabajo en equipo y el intercambio de información, disponible de modo cada vez más dinámico y con una amplitud insospechada tan solo hace unas décadas. Por otra parte, estos avances en muchas ocasiones no han sido fáciles para quienes los han impulsado, y diferentes controversias han puesto de relieve tanto la necesidad de veracidad en la investigación realizada como la perseverancia ante las dificultades e incomprensiones. Por ello, el presente trabajo de investigación intenta recuperar la importancia del factor humano y las decisiones personales como ejes clave del avance científico, también en lo que corresponde al estudio y tratamiento de los problemas de la sexualidad humana (AU)

The historical journey of Sexual Medicine and Andrology over the last 2 centuries makes it possible to illustrate how scientific development has grown to such a level that would have seemed impossible to our ancestors. This growth has largely contributed to the understanding of the physiology and, of course, the surgery, with the discovery of anesthesia, infection control and hemostasis. However, undoubtedly, the new culture of teamwork and the new possibilities of an increasingly dynamic exchange of information having an extension that was unsuspected only a few decades ago has also played an important part in this history.Moreover, in many cases these advances have not been easy for those who have encouraged them. Different controversies have highlighted both the need for accuracy in the research and perseverance against difficulties and misunderstandings. Therefore, the present research work has tried to recover the importance of the human factor and personal decisions as a key to scientific advance, as well as in that corresponding to the study and treatment of the issues of human sexuality (AU)

La Medicina Sexual en la Historia. Avances y controversias (Parte I) / Sexual Medicine beyond History. Advances and controversies (Part I)

La función sexual, su fisiología y su patología, han sido tremendamente mal entendidas a lo largo de la historia. Por otra parte, un aura de misterio relacionada con la incomprensión de los mecanismos que intervienen en la transmisión de la vida ha acompañado las teorías que, hasta el siglo XIX , han sido elaboradas sobre la concepción. Además, prejuicios, datos erróneos de investigación y, en algunas ocasiones, aportaciones fraudulentas, han enmarañado aún más los posibles conocimientos científicos sobre el papel de la sexualidad humana, dando lugar aun a mayores controversias. Por todo ello, los avances en posibles terapias quizás hayan sido más difíciles de conseguir que en otras áreas del conocimiento, aunque, finalmente, se hayan obtenido importantes logros tanto a nivel farmacológico como quirúrgico. El presente artículo realiza un recorrido sobre dichos avances y reflexiona sobre lo conseguido y lo que falta por conseguir(AU)

Sexual function, its physiology and pathology, have been widely misunderstood throughout history. Moreover, an aura of mystery regarding the misunderstanding of the mechanisms involved in the transmission of life has accompanied these theories until the nineteenth century. In addition, prejudice, wrong research data and, in some cases, fraudulent contributions, have further misdirected possible scientific knowledge on the role of human sexuality, leading to even greater controversies. This is why advances in potential therapies might have been more difficult to achieve than in other areas of knowledge although, in the end, important pharmacological and surgical achievements have been obtained. This article takes a journey on these developments and reflects on what has been achieved and what still needs to be achieved(AU)

Aproximación histórica al tratamiento quirúrgico de la disfunción eréctil / Historical Approach to the Surgical Treatment of Erectile Dysfunction

Introducción: A través de la historia de la humanidad la disfunción eréctil ha supuesto uno de los problemas de salud más continuamente presentes. Como consecuencia se produjo una búsqueda de soluciones que, una tras otra, se demostraban como infructuosas. En este contexto la aparición de posibles cirugías a principios del siglo XX supuso una revolución que, aun así, tardaría varias décadas en demostrarse efectiva. Adquisición de evidencia: Se realiza una revisión bibliográfica que muestra el proceso en el desarrollo de posibles tratamientos quirúrgicos de recuperación hormonal para la disfunción eréctil, posteriormente, la irrupción de la cirugía vascular, con nuevas técnicas de anastomosis y, más adelante, el desarrollo de los implantes de prótesis peneanas como alternativa terapéutica. Síntesis de evidencia: La publicación de resultados obtenidos con la cirugía para la disfunción eréctil ha carecido durante décadas de falta de objetivación, al ser la función sexual un tema restringido a la privacidad de los pacientes. Esta situación ha llevado a una confianza sobre los resultados referidos por varios autores sin poderse constatar su auténtica credibilidad, demostrándose posteriormente que algunos de estos logros no eran reproducibles. Conclusiones: En el presente artículo se recuerdan algunos de los hitos más importantes en el avance de las cirugías diseñadas para tratar la disfunción eréctil. Los logros conseguidos, y también los aparentes fracasos, ofrecen un motivo de reflexión sobre cómo se ha avanzado hasta el momento presente y cómo se puede avanzar en un futuro cercano (AU)

Introduction: Throughout human history, erectile dysfunction has represented one of the most omnipresent health problems. This has resulted in a search for solutions that, one after the other, have been shown to be fruitless. In this context, the emergence of possible surgical solutions at the start of the 20th century represented a revolution that, even then, would take several decades to demonstrate their effectiveness. Acquisition of evidence: We performed a literature review that shows the process in the development of potential surgical treatments for hormonal restoration for erectile dysfunction, followed by the sudden emergence of vascular surgery, with new anastomosis techniques, and in the future, the development of penile prosthetic implants as alternative treatments. Summary of the evidence: The publication of results from erectile dysfunction surgery has been lagging for decades due to a lack of objectivity, given that sexual function is a topic restricted by patients’ privacy. This situation has led to a reliance on results reported by various authors whose actual credibility could not be verified, with subsequent demonstrations showing that some of these results were not reproducible. Conclusions: This article reviews some of the most important milestones in the progress of surgeries designed to treat erectile dysfunction. The achievements and apparent failures provide a reason for reflection on how we far we have come and how far we can go in the near future(AU)

Historical approach to the surgical treatment of erectile dysfunction.

INTRODUCTION: Throughout human history, erectile dysfunction has represented one of the most omnipresent health problems. This has resulted in a search for solutions that, one after the other, have been shown to be fruitless. In this context, the emergence of possible surgical solutions at the start of the 20th century represented a revolution that, even then, would take several decades to demonstrate their effectiveness. ACQUISITION OF EVIDENCE: We performed a literature review that shows the process in the development of potential surgical treatments for hormonal restoration for erectile dysfunction, followed by the sudden emergence of vascular surgery, with new anastomosis techniques, and in the future, the development of penile prosthetic implants as alternative treatments. SUMMARY OF THE EVIDENCE: The publication of results from erectile dysfunction surgery has been lagging for decades due to a lack of objectivity, given that sexual function is a topic restricted by patients' privacy. This situation has led to a reliance on results reported by various authors whose actual credibility could not be verified, with subsequent demonstrations showing that some of these results were not reproducible. CONCLUSIONS: This article reviews some of the most important milestones in the progress of surgeries designed to treat erectile dysfunction. The achievements and apparent failures provide a reason for reflection on how we far we have come and how far we can go in the near future.

Frígidos y maleficiados. Las mujeres y los remedios contra la impotencia en la Edad Media / Frigid and bewitched: women and remedies against impotence in the Middle Ages

En la Edad Media las causas y origen de la impotencia masculina no sólo se atribuyó a diversas causas naturales, sino que también al poder de la brujería. Los médicos podían utilizar recetas antiguas, pero también recogieron remedios que fueron conocidos y utilizados por las mujeres. De modo que el mismo remedio era aceptable cuando lo respaldaba la medicina académica o se consideraba hechicería si lo utilizaban las viejas sabias (vetulae). Este trabajo explora los conocimientos de las mujeres sobre los tratamientos disponibles y su papel como sanadoras del cuerpo y la masculinidad de los hombres(AU)

During the Middle Ages, the causes and origin of male impotence were attributed not only to various natural causes but also to the power of witchcraft. Physicians could refer to treatments prescribed in the traditional medical canon but could also use remedies that were known to, and used by, women. As a result, the same cure could, in effect, be sanctioned when detailed by a male physicians but be condemned as witchcraft if it were to be prescribed by a female (vetulae). This study considers the knowledge that women had concerning available treatments for impotence, and their role in restoring feelings of male empowerment and masculinity(AU)

"It is caused of the womans part or of the mans part": the role of gender in the diagnosis and treatment of sexual dysfunction in early modern England.

Philip Barrough wrote in 1590 that barrenness 'is caused of the womans part or of the mans part'. By the eighteenth century, however, barrenness was perceived as a female disorder distinguished from male impotence. Few historians have addressed the uncertainty surrounding early modern definitions of infertility, choosing instead to adopt set terms that fit comfortably with modern ideas. This article will highlight the difficulties surrounding the gender distinction of the terms 'barrenness' and 'impotence' during this period. Moreover, the discussion will examine the role of gender in diagnosing these disorders to sufferers. The article will argue that ideas of gender were more central to diagnosis of poor sexual health than to effectual treatment. Although it appears that barrenness and impotence were treated with separate remedies, many treatments were described as effectual for both sexes. Additionally, the ingredients used in such recipes were often sexual stimulants explained without reference to gender.

[On warrior virgins, effeminate men, and infertility among ancient Scythians]. / Om krigeriske piger, kvindelige maend og infertilitet hos antikkens skythere. Hippokrates som kulturetnograf.

The Hippocratic text 'On the winds, waters and places' contains a fairly long description of an ancient Scythian tribe, the nomadic Sauromats. In this tribe the gender roles appear to have been inverted to some degree. The virgin women fight from horseback with swords, bows and arrows, and are not allowed to marry before they have killed three enemies. The married women are often infertile. The Hippocratic author ascribes this to the pronounced fatness of these women. Many men suffer from impotence and as a consequence dress as women, talk like them and carry out feminine household work. The Hippocratic author emphasises that the male impotence and the female infertility stem from the cold, damp climate and the Scythians' way of living, particularly the men spending most of their time riding. In contrast Herodotus states that the male impotence is Aphrodite's revenge because the Scythians ravaged her temple in Ascalon many years earlier. The difference between the Hippocratic emphasis on natural explanations for all natural phenomena, including health and disease and the occasional divine intervention promoted by Herodotus is underlined. There seems to be no plausible modern explanation for the impotence and infertility as described by the Hippocratic author.

Impotence in the 18th and 19th century: concepts of etiology and approaches to therapy.

The old word impotence is derived from the Latin word impotencia, which literally translated means "lack of power." Impotence, in the course of the history, has been attributed to mental pathology, anxiety, or demons or witches. Historically, the pharmacological treatments for impotence started in Greek times, when a myriad of herbal medications were applied locally to the genitals to enhance "sexual strength." In the 18th century, theories about the main factors inducing impotence saw it as an abnormal state of the fibers, a defect in the solid or liquid substances or a bad structure (tumor, inflammation, abscess, ulcer or foreign body). According to these mechanisms, when impotence depended on the state of the muscular fibers, treatment included a tepid bath and a clyster. In very fat or very weak people, who get particularly tired, it was important to use the remedies able to give energy to the fibers, such as ferrous mineral waters, for a month. Moreover, other suggestions were to ride a horse, to sleep few hours, to breathe good country air, to take a purge every 2 weeks, to drink half a glass of wine from Borgogne or to distract the mind continuously. In the 19th century, therapies regarding impotence included slight electric stimulation through the application of stimulators on the scrotum in the testis or epididymis areas, until pain was induced. In the same period, another method for treating impotence was flagellation. This method consisted of little flagellations with leather strips.

Sigmund Freud and his impact on our understanding of male sexual dysfunction.

INTRODUCTION: Sigmund Freud was one of the most influential thinkers and theorists of the 20th century. His groundbreaking work laid the foundation to many concepts and theories relevant to modern sexual medicine. AIM: To evaluate Freud's approaches to the understanding of male sexual dysfunction both in their historical context and with respect to their significance for contemporary research and therapy of sexual problems. METHODS: After a brief biographical sketch, two of Freud's writings, the widely acclaimed "Three Essays on the Theory of Sexuality" from 1905, and a short article entitled "The Most Prevalent Form of Degradation in Erotic Life" from 1912, were analyzed, especially for their relevance to present treatment concepts of male sexual dysfunction. RESULTS: In Freud's clinical practice "psychical impotence" was a highly prevalent complaint. In his view, this dysfunction was caused by an inhibition due to an unresolved neurotic fixation leading to an arrest of the libidinal development. The result is a splitting of the tender and the sensual dimension of sexuality, most notably in the so-called madonna-whore complex. The degree of this dissociation (total or partial) determines the severity of the ensuing sexual dysfunction. In Freud's rather pessimistic view, the erotic life of civilized people tends to be characterized by some degree of this condition. CONCLUSIONS: While some of Freud's theories are obsolete today, many parts of his work appear to be astonishingly modern, even in the light of current neurobiological research and recent models of sexual dysfunction. Above all, Freud was an extremely gifted observer of human behavior who shows us that in many cases, sexual dysfunctions are no isolated phenomena, but have their roots in biographically based intrapsychic or interpersonal conflicts.

Da impotência à disfunção erétil: destinos da medicalização da sexualidade / From impotence to erectile dysfunction: a journey through the medicalization of sexuality

Este artigo retrata a história recente da transformação do conceito da impotência, como desordem psicossexual, em disfunção erétil, considerada como uma doença de etiologia principalmente orgânica. Demonstra sucessivamente como a impotência masculina constituiu uma abrangência global de todo o ciclo da resposta sexual, e ainda, uma violação da identidade e da autoimagem; como o relacionamento entre casais se transformou progressivamente em dificuldade e como a falta de um órgão claramente circunscrito pode ser o objeto de um "simples" tratamento medicamentoso. Este processo foi analisado a partir de modelo sequencial da medicalização (Conrad), que permite compreender a intervenção dos diferentes atores envolvidos (cientistas, médicos, industriais, políticos, empresários). Compreende-se, assim, como as descobertas científicas são selecionadas e desenvolvidas de acordo com seu potencial industrial e são aplicadas às pesquisas clínicas; como entidades clínicas são reconceitualizadas e medidas através de investigações epidemiológicas na população em geral e como são criados os ensaios clínicos que levam à criação de um medicamento. Em seguida, observam-se como os atores da saúde pública e os políticos intervêm para dar legitimidade ao novo problema criado. Por fim, avalia-se a possibilidade da desmedicalização de problemas com o uso não-médico do medicamento, no contexto do desenvolvimento da autoprescrição na Internet.

This paper delineates the history of the recent transformation of the concept of impotence - from a psycho-social disorder to a disease with an organic etiology. Then it shows how male impotency, which globally affected the entire sexual response cycle, even acted upon self-image and the representation of the couple - progressively became a disorder as the failure of a well controlled organ liable to undergo a single medicinal treatment. This process is analyzed from the sequential model of medicalization, making the interference of the several actors implied (scientists, practitioners, industrialists, politicians, businessmen) easier to understand. This sheds light on the way scientific discoveries are selected and developed according to their industrial potential, then applied to clinical research; how clinical entities are reconceptualized and measured through epidemiologic studies among the general population, how clinical trials are conducted and how they lead to the creation and validation of a drug in public health settings. Next, we observe how public health actors and politicians are involved with giving this new problem legitimacy. Eventually, we evaluate the germs of de-medicalization, caused by the non-medical uses of the drug within the context of self-prescription which is currently developed on the Internet.

A política de atenção à saúde do homem no Brasil: os paradoxos da medicalização do corpo masculino / The Brazilian national policy for men's health: the paradoxical medicalization of masculinity

Este artigo trata do lançamento da Política Nacional de Atenção Integral à Saúde do Homem pelo governo brasileiro, em 2008. Analisamos as ações da Sociedade Brasileira de Urologia (SBU) nos anos que precederam o lançamento dessa política, e sua atuação durante sua implantação, focalizada na caracterização da disfunção erétil como problema de saúde pública. Examinamos em seguida o documento "Política Nacional de Atenção Integral à Saúde do Homem (princípios e diretrizes)", disponibilizado pelo Ministério da Saúde em agosto de 2008. A partir desses dados, buscamos discutir o modo como o discurso dos especialistas (no caso, os médicos urologistas) se articula ao discurso militante dos movimentos sociais, tendo como objetivo a medicalização do corpo masculino. Argumentamos que tal objetivo, sustentado na afirmação do direito à saúde, implica a ideia de uma masculinidade em si "insalubre", e visa, ao contrário das políticas voltadas para as mulheres e outras minorias, ao "desempoderamento" do sujeito à qual se dirige.

This paper discusses the launching of the Brazilian National Policy on Men's Health in 2008. We analyze the actions of the Brazilian Society of Urology while the policy was being planned and during its implementation. These actions can be described as an effort to promote "erectile dysfunction" as a public health problem. We then present the main points of the document "National Policy for the Integral Assistance to Men's Health (principles and guidelines)" launched by the Ministry of Health in August 2008. Based on this data, we discuss the way the specialists' discourse was articulated to the political discourse of social movements, with the aim of medicalizing man's body. We argue that the Policy, using the right to health as its justification, implies the idea of masculinity as intrinsically unhealthy, and, unlike the policies aimed at women and other minorities, aims at the "disempowerment" of men.