Vermox

Professor Michael R Pinsky

• Professor of Critical Care Medicine,
• Bioengineering and Anesthesiology
• University of Pittburgh
• Pittsburgh USA

The Guideline was modified where the Panel deemed necessary in response to these comments risk hiv infection kissing discount 100 mg vermox with amex. The guideline is expected to be updated when the Practice Guidelines Committee determines that additional treatments or evidence about existing treatments warrants a revision hiv infection rates houston purchase 100mg vermox mastercard. Florer Curtis Colby Copyright @2005 American Urological Association Education and Research hiv infection primary symptoms purchase vermox 100mg visa, Inc hiv infection rates in heterosexuals generic vermox 100mg without prescription. Vanderbilt University Patrick Florer Room A 1302, Medical Center North Diann Glickman, Pharm. Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative, randomized, crossover, multicenter study. Yohimbine for erectile dysfunction: a systematic review and meta analysis of randomized clinical trials. Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction. Double-blind, placebo controlled safety and efficacy trial with yohimbine hydrochloride in the treatment of nonorganic erectile dysfunction. Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non-organic male sexual dysfunction. Patient and partner satisfaction with Viagra (sildenafil citrate) treatment as determined by the Erectile Dysfunction Inventory of Treatment Satisfaction Questionnaire. Sildenafil citrate (Viagra) and erectile dysfunction following external beam radiotherapy for prostate cancer: a randomized, double-blind, placebo-controlled, cross-over study. Sildenafil citrate (Viagra) is effective and well tolerated for treating erectile dysfunction of psychogenic or mixed aetiology. A dose-escalation study to assess the efficacy and safety of sildenafil citrate in men with erectile dysfunction. An evaluation of Afrodex in the management of male impotency: a double blind crossover study. Oral trazodone is not effective therapy for erectile dysfunction: a double-blind, placebo controlled trial. The efficacy of anti-serotoninergic agents in the treatment of erectile dysfunction. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Vardenafil increases penile rigidity and tumescence in erectile dysfunction patients: a RigiScan and pharmacokinetic study. Effects of testosterone undecanoate on sexual potency and the hypothalamic-pituitary-gonadal axis of impotent males. Efficacy and safety of sildenafil citrate Viagra) in black and Hispanic Copyright @2005 American Urological Association Education and Research, Inc. Sildenafil effects on exercise, neurohormonal activation, and erectile dysfunction in congestive heart failure: a double-blind, placebo controlled, randomized study followed by a prospective treatment for erectile dysfunction. Efficacy and safety of oral sildenafil citrate (Viagra) in the treatment of male erectile dysfunction in Colombia, Ecuador, and Venezuela: a double-blind, multicenter, placebo controlled study. Efficacy and safety of a novel combination of L-arginine glutamate and yohimbine hydrochloride: a new oral therapy for erectile dysfunction. Onset and duration of action of sildenafil for the treatment of erectile dysfunction. Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. The efficacy and safety of oral sildenafil in Thai men with erectile dysfunction: a randomized, double-blind, placebo controlled, flexible dose study. Sildenafil citrate for treatment of erectile dysfunction in men with type 1 diabetes: results of a randomized controlled trial. Vardenafil, a New Phosphodiesterase Type 5 Inhibitor, in the Treatment of Erectile Dysfunction in Men With Diabetes: A multicenter double blind placebo-controlled fixed-dose study. Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: a randomized controlled trial. Sildenafil citrate (Viagra) in erectile dysfunction: near normalization in men with broad-spectrum erectile dysfunction compared with age matched healthy control subjects. Trazodone: a double blind, placebo-controlled, randomized study of its effects in patients with erectile dysfunction without major organic findings. Randomized trial of sildenafil for the treatment of erectile dysfunction in spinal cord injury. Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in Brazilian and Mexican men. Vardenafil, a New Phosphodiesterase Type 5 Inhibitor, in the Treatment of Erectile Dysfunction in Men With Diabetes: A multicenter double blind placebo controlled fixed-dose study. The effect of topically applied vasoactive agents and testosterone versus Copyright @2005 American Urological Association Education and Research, Inc. Efficacy and safety of oral sildenafil citrate (Viagra) in the treatment of male erectile dysfunction in Colombia, Ecuador, and Venezuela: a double-blind, multicenter, placebo-controlled study. Vardenafil for treatment of men with erectile dysfunction: efficacy and safety in a randomized, double-blind, placebo-controlled trial. Sustained efficacy and tolerability of vardenafil, a highly potent selective phosphodiesterase type 5 inhibitor, in men with erectile dysfunction: results of a randomized, double-blind, 26-week placebo controlled pivotal trial. Evaluation of transurethal alprostadil for safety and efficacy in men with erectile dysfunction. Combination therapy for erectile dysfunction: a randomized, double blind, unblinded active-controlled, cross-over study of the pharmacodynamics and safety of combined oral formulations of apomorphine hydrochloride, phentolamine mesylate and papaverine hyd. Efficacy and safety of fixed dose oral sildenafil in the treatment of erectile dysfunction of various etiologies. Treatment of antidepressant associated sexual dysfunction with sildenafil: a randomized controlled trial. Efficacy and tolerability of vardenafil for treatment of erectile dysfunction in patient subgroups. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at home clinical trial. Sildenafil: study of a novel oral treatment for erectile dysfunction in diabetic men. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Vardenafil increases penile rigidity and tumescence in men with erectile dysfunction after a single oral dose. Urinary frequency Urticaria Urticaria Vaginal burning (partner) Vaginal burning (partner) Visual Blue Color Vision Visual Copyright @2005 American Urological Association Education and Research, Inc. Data published on injection therapies and vacuum constriction devices did not warrant close examination or change from the initial guideline, and the outcomes tables from the 1996 Report on the Treatment of Organic Erectile Dysfunction (the 1996 Report) should be used as a reference for these treatments ( For most treatments, methodologies and outcome measures varied considerably across studies, making analyses of outcomes data difficult and precluding the combining of data for meta-analysis. First, studies evaluating vardenafil and tadalafil excluded subjects who did not respond to sildenafil. Second, because many of the studies identified through the original literature search used mathematical models to compensate for patient variability in age, race, smoking status, and baseline function 17,18,19,20,21. Although authors of 22,23 previously published evidence-based reviews had obtained raw data directly from study investigators for meta-analytic purposes, the Panel believed that even if the raw data were obtained, useful comparisons still could not be made due to the incomparable patient populations. With these caveats, details of the meta-analytic process are described below and the supporting evidence is presented in Appendices 3-A to 3-D. As described in Chapter 2, meta-analyses of randomized controlled trial data alone were performed in addition to meta-analyses of all clinical series data, including each treatment arm of the randomized controlled trials. A few of these reviews took steps to address the analytic problems recognized by the Panel. The Panel decided to obtain and assess unadjusted data only if the results were expected to be different from those previously published. Because findings using adjusted and unadjusted data were similar, the Panel did not believe that obtaining and reanalyzing the unadjusted data would significantly contribute to the literature assessment. Including any reported dose, the difference from placebo at follow-up ranged from 36% to 76%.

The presence of two or more of the high risk features listed below upstages a lesion 2 cm or less in greatest dimension from T1 to T2 hiv infection rate in libya order vermox now. The code structure and definitions are the same as for site-specific factor 1 in the head and neck sites ear infection hiv symptoms purchase vermox 100mg with mastercard. The measurement may be clinical or pathologic (pathologic takes priority if there has been no neoadjuvant therapy) hiv infection flu like symptoms purchase 100 mg vermox with amex. For Merkel cell carcinoma hiv infection unprotected purchase vermox line, thickness is measured in tenths of millimeters, not hundredths as in the Breslow measurement for melanoma. Micrometastases are diagnosed after removal and microscopic examination of the lymph nodes (sentinel node biopsy or lymphadenectomy). Extracapsular extension is an adverse prognostic factor not only for Merkel cell carcinomas, but for any primary site where lymph nodes are involved. Clinical extracapsular extension may be described as lymph nodes that are fixed or matted. Code whether extracapsular extension is present clinically and/or pathologically of any involved regional lymph node(s). In other words, the surgeon cut through the deepest part of the tumor and left malignant cells behind which have the potential to recur at the primary site or spread elsewhere. Assign the code that best describes the status of tumor infiltrating lymphocytes based on statements in the pathology report. In most cases the tumor is centered in the dermis or sometimes in the subcutaneous tissue and usually does not involve the epidermis as cutaneous melanoma does. Immune suppression is due to a lack of T lymphocytes (key cells of the immune system) and patients who have this defect have 10-30 times higher risk of Merkel cell carcinoma. Staging of mycosis fungoides includes analysis of the circulating blood for Sezary cells. The lack of monoclonality (clone negative) generally indicates a better prognosis. It should be noted that stage grouping uses essentially a two tier system, where grade 1 is categorized as low grade and grades 2 and 3 are categorized as high grade. Grading should be attempted for all sarcomas, although a fine needle or core needle biopsy may not yield enough tissue to classify the tumor in a three grade system. Do not code well differentiated or poorly differentiated or similar terminology in this field. If the only information available is low grade or high grade, use code 100 or 200 as appropriate. For peritoneum, a schema discriminator is necessary to identify the gender of the patient so that the correct schema can be presented to the abstractor. They usually do not show evidence of malignant activity in the nodes, such as proliferation or stromal reaction. In histology, the standard or routine stain is the hematoxylin and eosin stain, better known as the H&E stain. With most disease states there is abnormal growth and/or division in the nucleus of the cells. The hematoxylin and eosin stain uses two separate dyes, one staining the nucleus and the other staining the cytoplasm and connective tissue. Hematoxylin is a dark purplish dye that will stain the chromatin (nuclear material) within the nucleus, leaving it a deep purplish-blue color. This counterstain acts as a sharp contrast to the purplish-blue nuclear stain of the nucleus, and helps identify other entities in the tissues such as cell membrane (border), red blood cells, and fluid. Note that the table includes codes for axillary nodes only, not internal mammary nodes. Within that group, find the row or rows that represent the information in the case, and read right to the last four columns to find the codes to use. Cytokeratin H&E neg, molecular 000 000 002 002 stain showed clusters of tumor cells in the node studies done, pos for up to 0. Therefore, the code for borderline will rarely, if ever, be used for diagnoses 2010 forward. This field does not affect stage grouping, but can be used if needed by a researcher to analyze differences in outcomes within a T category. The score based on three factors: degree of tubule formation (histologic grade), mitotic activity, and nuclear pleomorphism (nuclear grade). Each of the factors receives a score of 1, 2, or 3, based on specific pathologic criteria. Definitions of positive and negative interpretations for the test vary from one lab to another. The code structure for this field is similar to other lab tests requiring an interpretation. Amplification: >5 signals/nucleus, or cluster of amplified signals/nucleus in >50% of tumor cells. Younger women, African American women, and Hispanic women are more likely to be triple negative than older women and Caucasians, meaning that they are unlikely to respond to hormone therapy or Herceptin as part of their breast cancer treatment. The values in each digit are simply 0 for a negative test result and 1 for a positive test result. The number of circulating tumor cells before treatment is an independent predictor of progression-free survival and overall survival in patients with metastatic breast cancer. The concentration process is created by a magnet placed on the side of the test tube bringing the beads to it. If distant metastasis is coded as 000 (no positive metastasis), this field must also be coded to 000. This site-specific factor documents whether that neoadjuvant therapy was successful. It is commonly associated with an underlying cancer in the breast, in which case the presence of Paget disease is disregarded and staging is based on the underlying tumor. Code any statement of Paget disease, clinical or pathologic, giving priority to the pathologic assessment. Use code 999 unknown when there is no clinical or pathologic examination of the nipple described in the medical record. In English, the organization is the International Federation of Gynecology and Obstetrics. For example, three positive nodes would be coded in Regional Lymph Nodes Positive as 03 and in the site-specific factor as 003. When status and assessment of lymph nodes is requested (cervix, vulva and vagina), status refers to positive or negative, and assessment is the method by which the positive nodes were determined. Regional Lymph Nodes for can be coded from the pathology report, imaging or other Female Genital Organs information in the record. For all lymph node fields, code statements by the clinician or pathologist as appropriate.

Common elements treatment approach based on a Cognitive Behavioral intervention: implementation in the Colombian Pacifc hiv infection rates by activity purchase 100 mg vermox with mastercard. MediCapt in the Democratic Republic of the Congo: the Design hiv infection 2 years purchase vermox 100mg otc, Development herpes zoster antiviral drugs buy generic vermox pills, and Deployment of Mobile Technology to Document Forensic Evidence of Sexual Violence stages of hiv infection to aids buy generic vermox on line. A randomized controlled trial of trauma-focused cognitive behavioral therapy for sexually exploited, war-affected congolese girls. Social construction of masculinity and male survivors of wartime sexual violence: an analytical review. Realist review a new method of systematic review designed for complex policy interventions. Where are male victims of confict-related sexual violence in international law and policy Psychological therapies for the treatment of mental disorders in low-and middle-income countries affected by humanitarian crises. The complexities of the religious response to domestic violence: Implications for faith-based initiatives. Effect of group vs individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. Male sexual abuse: A review of effects, abuse characteristics, and links with later psychological functioning. Gender and dimensions of the self: Implications for internalizing and externalizing behavior. Briefng paper: Care and support of male survivors of confict-related sexual violence. Humanitarian Emergencies, 72 (Special issue Mental health and psychosocial support in humanitarian crises). Cognitive-behavioral treatment of rape and war-related posttraumatic stress disorder with a female, Bosnian refugee. International Security and Peacebuilding: Africa, the Middle East, and Europe, Jan 30: 77. Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providersattitudes, knowledge, confdence, and practice in humanitarian settings. What evidence exists for initiatives to reduce risk and incidence of sexual violence in armed confict and other humanitarian crises Mechanisms underpinning interventions to reduce sexual violence in armed confict: A realist informed systematic review. Health-care needs of people affected by confict: future trends and changing frameworks. Using a social construction of gender lens to understand gender differences in post-traumatic stress disorder. Piloting community-based medical care for survivors of sexual assault in confict-affected Karen state of eastern Burma. Towards male centric communication: sensitising health professionals to the realities of male childhood sexual abuse survivors. Evaluation Report: Ensuring recognition of sexual violence as a tool of confict in the Nepal peace building process through documentation and provision of comprehensive services to women and girl survivors. Mental health and psychosocial support in humanitarian settings: linking practice and research. Sexual and gender-based violence in areas of armed confict: a systematic review of mental health and psychosocial support interventions. Mental health and psychosocial support in humanitarian settings: a public mental health perspective. The association of perseverative negative thinking with depression, anxiety, and emotional distress in people with long term conditions: A systematic review. Sexual and Gender Based Violence against Refugees, Returnees, and Internally Displaced Persons; Guidelines for Prevention and Response. Working with Men and Boy Survivors of Sexual and Gender-based Violence in Forced Displacement. Caring for Child Survivors of Sexual Abuse: Guidelines for health and psychosocial service providers in humanitarian settings. Ending violence and discrimination against lesbian, gay, bisexual, transgender and intersex people. Minimum Standards for Prevention and Response to Gender-Based Violence in Emergencies. Toolkit for Monitoring and Evaluating Gender-Based Violence Interventions Along the Relief to Development Continuum. The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Gender difference in outcomes following trauma-focused interventions for posttraumatic stress disorder: Systematic review and meta-analysis. Effcacy of an internet-based intervention for posttraumatic stress disorder in Iraq: A pilot study. Labels, gender-role confict, stigma, and attitudes toward seeking psychological help in men. Role of gender in depressive disorder outcome for individual and group cognitive-behavioral treatment. Systematic review of the evidence on the effectiveness of sexual and reproductive health in humanitarian crises. Developing inter-agency guidelines on mental health and psychosocial support in emergency settings. Do no harm: Challenges in organizing psychosocial support to displaced people in emergency settings. Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial. Clinical Management of Rape Survivors Developing protocols for use with refugees and internally displaced persons. The survey consisted of two parts: a household-level survey of women and men and a community survey around the sample points from which the households were selected. Preparations for the survey started in mid-2003 and the fieldwork was carried out between January and May 2004. The findings of this report will be instrumental in assessing the achievements of family planning, nutrition, and health programs. The report provides estimates of key indicators by socioeconomic and demographic differentials. The final report supplements the pre liminary report, which was released earlier. I believe that the information obtained from this survey will help the policymakers and program managers in the formulation of new programs and monitoring the on going programs. The data indicate there has been a decline in the total fertility rate and a steady increase in contraceptive use. While the survey results are encouraging, there is still a long way to go to achieve the national health and demographic goals. Financial support for the survey was provided Bangladesh, 122 in urban areas and 239 in the by the U. It is designed to provide data to monitor the population and health Fertility Levels and Trends. In 1971-1975, situation in Bangladesh as a followup to the 1993 women in Bangladesh were having on average 6. The survey obtained detailed information on fertility levels, marriage, fertility preferences, Fertility Differentials. Differentials in fertility awareness and use of family planning methods, by background characteristics are substantial. Women breastfeeding practices, nutritional status of in rural areas have more children than their urban women and young children, childhood mortality counterparts (3. The proportion of unwanted births did not by 7 percent of married women, is the most com change. Over the past desire among currently married Bangladeshi three decades, use of any method of contraception by women to stop having children. A total of 54 per married women has increased sevenfold, from 8 to 58 cent of women age 10-49 reported not wanting percent, while use of modern methods has increased another child, and 6 percent are already sterilized.

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Syndromes

• Dried fruit, served with nuts or sunflower or pumpkin seeds
• Fainting or feeling lightheaded
• Serum follicle stimulating hormone
• Movement disorder
• Pouch-like sacs called diverticula on the walls of the bladder or urethra
• Marfan syndrome
• Blindness

Accidents that cause severe pelvic fracture or direct injury to the penis are at risk for erectile dysfunction hiv infection rate cambodia buy vermox line. Diabetes A major physical cause of impotence antiviral tincture discount vermox 100mg, diabetes can also accelerate other causes like penile artery damage from cholesterol may become significant in a shorter period of time than it would if not complicated by diabetes antiviral yify buy generic vermox 100mg on line. High cholesterol Impotence research in the past several years has led a few authorities such as the New England Male Reproductive Center at Boston University Medical Center to conclude that high cholesterol is "probably one of the leading causes of impotence in America hiv infection rate switzerland purchase vermox 100 mg with visa. The penis is a vascular organ, made up of layers of venous tissue and blood vessels. Prostate problems Chronic pain and swelling in the prostate area can affect sexual functioning in an indirect manner if a man finds erection or ejaculation painful or uncomfortable. Radiation therapy the administration of radiation to kill cancer cells for colon cancer or prostate cancer can cause damages to the blood vessels supplying to the penis. A study reported by the Journal of the American Medical Association showed that 25 per cent of all sex problems in men were caused or complicated by medications and other drugs. Tranquilizers, antidepressants, some high-blood-pressure drugs, corticosteroids (taken for arthritis), analgesics (for pain), alcohol, tobacco, and illegal drugs such as cocaine and marijuana affect libido and performance in men. Others Surgery or other factors unrelated to disease can also cause erectile dysfunction. Habitual lifestyle like alcoholism, tobacco, eating habit and diet that causes malnutrition and lead to obesity. Consider his age, at 50 plus, the onset and period of his problem, his medical background, the severity of the problem and other factors which may involve. Some change was inevitable, but some men were experiencing too much change especially if they had it earlier. Healthier lifestyles will most likely lead to healthier erections but as any man can expect to lose an erection during lovemaking on occasion. There are always ways to improve the quality of your erections, extend penis longevity and minimize the possibilities of losing an erection during lovemaking by adopting some following suggestions: 1. Smoking causes much of the vascular damage In the penis that could result in impotent. Long term and heavy smokers have a greater probability of becoming impotent than do non-smokers. One recent study found that men who smoked a pack a day for 20 years had a 60 percent greater chance of becoming impotent than non smokers. After several months or a year of not having an erection, a man may have difficulty in achieving one. Once you take the pressure to ejaculate out of lovemaking, you will probably have more frequent erections, sustain them longer, and enjoy the experience much more. A man is also more likely to have erection difficulties if his lovemaking style is intercourse driven. The pressure to perform will be greater for him than for a man who enjoys satisfying his partner in a variety of ways. If intercourse has always ended in ejaculation until recently, she may think she has failed to excite you sufficiently. She has been able to enjoy inter course without needing to reach an orgasm every time. Masturbation two or three times in a week helps in achieving erections for older male. By having a sustained erection, you can take your mind off your penis because you will know that you are capable to sustained erection even if you ejaculate. When a doctor prescribes a drug, ask about its sexual side effects, if an alternative drug might not have the same side effects, and whether or not a lifestyle change would enable you to go off medication as soon as possible. Ejaculation Incompetence the process of Ejaculation Have you ever wonders how the whitish or cloudy fluid shoots out from the penis Coincidentally, the second stage of ejaculation is the eruption of the semen out of the urethra. After the orgasm and volcanic eruption of the penis, the erection usually returned to its flaccid state. Hence, is difficult to have another erection or ejaculation again in a short time. Most definitions refer specifically to the duration of intra-vaginal containment of the penis or a man who cannot control his ejaculatory process for at least the first 3 seconds after penetration. In 1981, the Hite Report on Male Sexuality was based on a survey of over 7000 men and found that 2% of these men ejaculated within 60 seconds of penetration. Only one in six men lasted for over five minutes after penetration, and only one in ten lasted over ten minutes. The report also showed that there is no difference between races, circumcised men and non-circumcised men. Most men say that they would like to sustain their erection long enough to satisfy their partner. More than 30% of men suffer severe premature ejaculation and almost all men will occasionally ejaculate very quickly. Any man who says it has never occurred to him is probably either a virgin or a liar. The big head should be controlling the small head rather than the other way around. If this sensitivity is too great, very little contact is needed to bring on ejaculation. This sensitivity can actually be measured by using a machine called a biosthesiometer. If your penis can pick up very low amplitude vibrations, then the penis is regarded as being highly sensitive. On the contrary, 3 to 60 seconds of intra-vaginal containment is quite sufficient to satisfy a woman, if she has been highly excited during sex play and is fully ready for orgasmic release with the initial thrusts of the penis. However, during most coital opportunity, the same woman may require variably longer periods of penile containment before attaining full release of sexual tension. Psychological In the majority of men with premature ejaculation, the origin is psychological. An enormous pressure to perform is placed on the shoulders of a poor young man who is about to embark on his first important task. With the repeatable bad experiences, the more he thinks about it the worse it gets. The complainant usually the partner instead of showing concern, rolls her eyes up in disappointment. If the male ejaculates regularly during mounting sex play or during attempts at mounting or even with the first few thrusts, there rarely is opportunity for effective female sexual expression. Particularly when this male response pattern is repeated routinely time after time. Subsequently after ejaculation, they could sometimes pretend nothing had happened. That is, after ejaculating, the thrusting still continues until the partner looked satisfied or until next possible ejaculation again. Premature Ejaculation is good at times Rapidity of ejaculation is not considered a sexual hazard, in fact it may provide welcome relief for the woman accepting and fulfilling a role as a sexual object without exposure to or personal belief in the concept of parity between the sexes in the privileges and the pleasures of sexual functioning. Ejaculation Incompetence in Aging Male the Aging Effect the alteration of sexual patterning is probably the most important psycho physiological in midlife especially 50 to 70 year period. So many men in the older age groups consider them old fart and are too old to function sexually, yet cannot explain how they have arrived at this conclusion. As age rises, he not only enjoys an unexpected increase in ejaculatory control but also at the same time has a definite reduction in ejaculatory demand. Example, if a 60 plus years old man has intercourse on an average of once or twice a week, his own specific drive to ejaculate might be of major moment every second or third time there is coital connection. This level of innate demand does not imply that the man cannot or does not ejaculate more frequently. He can force himself or be forced by the partner to ejaculate more frequently, but if left to resolve his own individual demand level he may find that an ejaculatory experience every second or third coital connection is completely satisfying personally. Explicitly his own subjective level of ejaculatory demand does not keep pace with the frequency of his physiological ability to achieve an erection or to maintain this erection with full pleasure on an indefinite basis. This reduction of ejaculatory demand for the aging male is the entire basis for effective prolongation of sexual functioning in the aging population.