A vasectomy of any type ranks among the most effective means of protection from pregnancy.(The success rate is over 99 percent.)

Although no procedure is totally safe or effective, the failure rate for a vasectomy is less than one percent. (By comparison, the failure rate for latex condoms is 12 percent or more; for diaphragms, it’s 18 percent.) Couples who want a highly reliable and permanent form of contraception often opt for a vasectomy where the success rate is over 99 percent.

1. With conventional or the traditional vasectomy, the surgeon uses a scalpel to make a small incision on each side of the scrotum, allowing access to each vas deferens. The vas deferens is severed, and usually a small piece removed. It is then is tied-off and/or cauterized to make the seal. The surgeon (and/or patient) may elect to forgo some of the “traditional” methods in favor of newer variations as described below.

2. A no-scalpel vasectomy (termed key-hole), in which a sharp hemostat, rather than a scalpel, is used to puncture the scrotum. It may reduce healing times as well as lower the chance of infection from incision. Usually, there are no stitches needed.

3. In an “open-ended” vasectomy, the testicular end of the vas deferens is not sealed, which allows continued streaming of sperm into the scrotum. This method may avoid build-up of pressure in the epididymis. Testicular pain (from “backpressure”) may also be reduced using this method.

4. A “Vas-Clip” vasectomy does not require cutting the vas deferens, but rather uses a clip to squeeze shut the flow of sperm. This method may facilitate a better chance or outlook for reversal, as well as reduced pain (post-procedure). Statistics suggest a much lower overall success rate compared to traditional methods[citation needed].

5. A fascial interposition vasectomy has a fibrous layer surrounding the vas deferens that is pulled away from and sewed around it which helps prevent failure due to “recanalization”.

6. What is a “No-Scalpel” Vasectomy (NSV)?
   The No-Scalpel technique is one of two main methods surgeons use to perform a vasectomy. Many doctors favor the No-Scalpel method because – unlike the traditional vasectomy approach – a scalpel is not required and there are no incisions (only one or two small openings in the skin). In addition, the NSV often results in less discomfort after the procedure with a reduced risk of bleeding or infection. Also, there is no perceptible scarring.

   How long does the No-Scalpel procedure and recovery take?

   The procedure itself usually takes about 15 minutes, sometimes less. However, including the office routine, paperwork and preparation, the total time in a doctor’s office may be about an hour. The procedure is likely to produce tenderness, discomfort and slight swelling in the first two or three days afterwards, with a return to nearly all usual activities typically within a week. (Follow your doctor’s instructions carefully, take your time and use the schedule that is right for you.)

   How effective is a No-Scalpel vasectomy?
   It is the most effective means of protection from pregnancy.
   The failure rate for a vasectomy is less than one percent. Success rate is over 99 percent.
   (By comparison, the failure rate for latex condoms is 12 percent or more; for diaphragms, it’s 18 percent.)

7. Vasectomy Reversal Methods
   
   You should consider any vasectomy to be permanent. There are delicate microsurgery operations that may be able to reverse the effects of a vasectomy, but there is no assurance that the flow of sperm can be restored or pregnancy will result in every case. The likelihood of success can vary greatly depending on individual circumstances, including how much time has passed since the vasectomy. If you are seriously considering a vasectomy, it’s best to assume that it will be a permanent change.

Have no doubt that the male sterilization operation is DEFINITELY better than the female sterilization.

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Reasons:

• (a) In male it is not necessary to puncture abdomen. In women however, you have to reach inside the abdomen and work near the intestines and other organs.
• (b)
  Hence, in a woman there is a definite risk of infection. This intra-abdominal infection can spread and may be difficult to control.
• (c)
  Gynecologist trained and certified in laparoscopic procedures does the female sterilization.
  In experts hand tubectomy is safe.
• (d) Surgeon goes beneath the scrotal skin, he can see the vas deferens and carry out the appropriate clamping of the vas.
• (e)
  Quicker recovery and quicker resuming of usual activities.
• (f)
  Male Sterilization is less expensive.
• (g)
  If in future the couple want children due to unforeseen event the success of re canalization is far better and easier in men than in women who have undergone tubectomy.

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Q2
What is sterilization?
When a couple do not wish to have any more children then the method of permanent birth control, vasectomy in the male and tubectomy in the female, called sterilization is used.
Q3
What is vasectomy? ^[2]
A vasectomy is performed by cutting or clamping the vas deferens, the small tube that carries sperm from the man’s testicles to seminal vesicles.
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Q4
Does vasectomy affect sex adversely?
The man who has undergone vasectomy continues to have sexual intercourse, enjoys climax, and as USUAL discharges semen during ejaculation. The sexual functions are TOTALLY NORMAL, sometimes better because the hassle of wearing a condom or withdrawing at the last moment are not required. Actually if not told that an operation has been done, neither the man himself, nor the doctor, nor the female partner will know that vasectomy has been performed. The only method to confirm vasectomy was performed is by doing analysis of semen, which will show under microscope zero sperm count. Thus sex between the couple can continue happily ever after without risk of pregnancy.
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Q5
What are the methods of vasectomy?
This is given in the next chapter.

Q6
What is tubectomy?
Tubectomy is the procedure of cutting or clamping the Fallopian tubes that are inside the abdomen.
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REFERENCES
[1] www.vasectomy.com
[2] wikipedia

In various clinical studies, very good responses to testosterone have been reported for men with low-testosterone and they include:

1. * Improvement in mood and sense of well-being
2. * Increased mental and physical energy
3. * Decreased anger, irritability, sadness, tiredness, nervousness
4. * Improved quality of sleep
5. * Improved libido and sexual performance
6. * An increase in lean body mass, a decline in fat mass
7. * An increase in muscle strength (hand grip, upper and lower extremities)
8. * Potentially, a decrease in the risk of heart disease

With testosterone therapy, one’s attitude improves, reinforcing self-esteem and self-confidence at work, as well as an increased energy at home and in social activities. Most men will feel more vigorous, experience improved energy levels, mood, concentration, cognition, libido, sexual performance and an overall sense of well-being. These effects are usually noted within 3 to 6 weeks.

Other potential benefits include maintenance or improvement in bone density, improved body composition, muscle mass and muscle strength, as well as improvement in visual-spatial skills.”

OTHER USES OF TESTOSTERONE
Testosterone supplementation is indicated for treatment of testosterone deficiency, including hypogonadism, andropause and related conditions such as delayed puberty in boys. 

Source:
www.andropause.ca

Maintenance dose of 40 – 120 mg daily

TESTOSTERONE DOSE

Source
www.andropause.ca

www.andropause.ca

© 2008 Schering-Plough Corporation.

[1] TESTOSTERONE AND HEART ATTACK
[2] RISKS OF TESTOSTERONE
[3] HOW TO MANAGE RISKS AND SIDE EFFECTS OF TESTOSTERONE?
[4] WHICH TESTOSTERONE IS BETTER?

[1] TESTOSTERONE AND HEART ATTACK

Older Men With Higher Testosterone Levels More Likely To Have A Heart Attack
Last Updated: 2010-07-02T16:59:21+05:30

“The study finding contradicts smaller studies that have shown that testosterone levels are not associated with higher rates of cardiovascular disease,” said Kristen Sueoka, physician at the University of California, San Francisco.
Dr. Sueoka said: During a follow-up after four years, 100 men, or about 14 percent, had a coronary disease event, in particular, heart attacks.
 
After the researchers adjusted for other potential contributing risk factors for heart disease, such as elevated cholesterol, they found that higher total testosterone level relates to an increased risk of coronary disease, said a university release.
 Study participants were aged 65 or above and included 697 community-dwelling men who were participating in the National Institutes of Health-funded study, Osteoporotic Fractures in Men (MrOS).
The results were presented at The Endocrine Society’s 92nd Annual Meeting in San Diego.
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[2] RISKS OF TESTOSTERONE
There are several conditions in which you should never use testosterone replacement therapy. These include:

1. Breast cancer (in males)
2. Prostate cancer
3. In some other cases testosterone replacement therapy may not be right for you. If one of the conditions below is applicable to you, your doctor will decide whether (in your specific case) testosterone replacement therapy is the right solution.
4. Liver disease
5. Heart or blood vessel disease
6. Edema (swelling of face, hands, feet, or lower legs)
7. Enlarged prostate
8. Kidney disease 
9. Diabetes mellitus (sugar diabetes)

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[3] HOW TO MANAGE RISKS
To help your doctor determine your best treatment plan, you should also discuss the following:

• If you have ever had any unusual or allergic reaction to androgens or anabolic steroids.
• If you are an adult male who plans to have children; high doses of androgens may cause infertility.
• If you are bedridden.
• If you are now taking any other prescription or nonprescription (OTC) medicine,  especially anticoagulants (blood thinners).

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[4] WHICH TESTOSTERONE IS BETTER
Options include

• oral capsules,
• gel,
• injections and
• skin patches.

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SOURCES

india-server.com/news/older-men-with-higher-testosterone
© 2008 Schering–Plough Corporation. All rights reserved.
my.clevelandclinic.org/disorders/male_menopause
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life syle changes to improve erection

How Does the Penile Prosthesis Work?

The inflatable penile prosthesis consists of two cylinders — a reservoir and a pump — which are placed surgically in the body.

The two cylinders are inserted in the penis and connected by tubing to a separate reservoir of fluid. The reservoir is implanted under the groin muscles. A pump is also connected to the system and sits under the loose skin of the scrotal sac, between the testicles.

To inflate the prosthesis, the man presses on the pump. The pump transfers fluid from the reservoir to the cylinders in the penis, inflating them and causing an erection. Pressing on a deflation valve at the base of the pump returns the fluid to the reservoir, deflating the penis and returning it to the normal flaccid state.
Attribution:
webMD

A

• Acceptance and commitment therapy (ACT)
  
• Adlerian therapy
  
• Adventure therapy
  
• Analytical psychology
  
• Art therapy
  
• Attack therapy
  
• Attachment-based therapy (children)
  
• Attachment therapy
  
• Attachment-based psychotherapy
  
• Autogenic training
  

[edit]B

• Behavior modification
  
• Behavior therapy
  
• Biodynamic psychotherapy
  
• Bioenergetic analysis
  
• Biofeedback
  
• Bionomic psychotherapy
  
• Body psychotherapy
  
• Brief therapy
  

[edit]C

• Classical Adlerian psychotherapy
  
• Characteranalytic vegetotherapy
  
• Chess therapy
  
• Child psychotherapy
  
• Client-centered psychotherapy
  
• Co-counselling
  
• Cognitive analytic psychotherapy
  
• Cognitive behavior therapy (CBT)
  
• Coherence therapy
  
• Collaborative therapy
  
• Concentrative movement therapy
  
• Contemplative psychotherapy
  
• Conversational model
  
• Conversion therapy
  
• Core process psychotherapy
  

[edit]D

• Dance therapy
  
• Depth psychology
  
• Daseinsanalytic psychotherapy
  
• Developmental Needs Meeting Strategy (DNMS)
  
• Dialectical behavior therapy (DBT)
  
• Dreamwork
  
• Drama therapy
  
• Dyadic Developmental Psychotherapy (DDP)
  

[edit]E

• Ecological Counseling
  
• Emotion Focused Therapy
  
• Emotional Freedom Techniques (EFT)
  
• Encounter groups
  
• Etiotropic Trauma Management (ETM)
  
• Experiential Therapy
  
• Eye Movement Desensitisation and Reprocessing (EMDR)
  
• Existential therapy
  
• Exposure and response prevention
  
• Expressive therapy
  

[edit]F

• Family Constellations
  
• Family therapy
  
• Feminist therapy
  
• Functional Analytic Psychotherapy (FAP)
  
• Focusing
  
• Freudian psychotherapy
  

[edit]G

• Gestalt therapy
  
• Gestalt Theoretical Psychotherapy
  
• Grinberg Method
  
• Group Analysis
  
• Group therapy
  
• Guided Imagery Therapy
  

[edit]H

• Hakomi
  
• Holistic psychotherapy
  
• Holotropic Breathwork
  
• Holding therapy
  
• Humanistic psychology
  
• Human givens psychotherapy
  
• Hypnotherapy
  

[edit]I

• Integrative body psychotherapy
  
• Integral Eye Movement Therapy
  
• Integral psychotherapy
  
• Integrative psychotherapy
  
• Intensive short-term dynamic psychotherapy
  
• Internal Family Systems Model
  
• Internet based psychotherapy
  
• Interpersonal psychoanalysis
  
• Interpersonal psychotherapy
  

[edit]J

• Jungian psychotherapy
  

[edit]K

[edit]L

• Logotherapy
  

[edit]M

• Marriage counseling
  
• Milieu Therapy
  
• Mindfulness-based Cognitive Therapy
  
• Mindfulness-Based Stress Reduction (MBSR)
  
• Mentalization based treatment (MBT)
  
• Method of Levels (MOL)
  
• Morita Therapy
  
• Motivational Interviewing
  
• Multimodal Therapy
  
• Multitheoretical Psychotherapy
  
• Music therapy
  

[edit]N

• Narrative Therapy
  
• Neuro-linguistic programming (NLP)
  
• Nonviolent Communication
  

[edit]O

• Object Relations Psychotherapy
  
• Orgonomy
  

[edit]P

• Parent-Child Interaction Therapy (PCIT)
  
• Pastoral counseling/therapy
  
• Person-centered (or Client-Centered or Rogerian) psychotherapy
  
• Personal construct psychology (PCP)
  
• Play therapy
  
• Positive psychology
  
• Postural Integration
  
• Primal therapy
  
• Primal integration
  
• Process Oriented Psychology
  
• Process Psychology
  
• Prolonged Exposure Therapy
  
• Provocative Therapy
  
• Psychedelic psychotherapy
  
• Psychoanalytic psychotherapy
  
• Psychoanalysis
  
• Psychodrama
  
• Psychodynamic psychotherapy
  
• Psychosynthesis
  
• Psychosystems Analysis
  
• Pulsing (bodywork)
  

[edit]Q

[edit]R

• Radix therapy
  
• Rational Emotive Behavior Therapy (REBT)
  
• Rational Living Therapy (RLT)
  
• Rebirthing-Breathwork
  
• Recovered Memory Therapy
  
• Re-evaluation Counseling
  
• Reiki
  
• Relationship counseling
  
• Relational-cultural therapy
  
• Relational Empowerment Therapy
  
• Reprogramming
  
• Reality therapy
  
• Rubenfeld Synergy
  
• Reichian psychotherapy
  
• Rolfing
  

[edit]S

• Self-relations Psychotherapy or Sponsorship
  
• Sensorimotor Psychotherapy
  
• Sexual Identity Therapy
  
• SHEN Therapy
  
• Social therapy
  
• Solution focused brief therapy
  
• Somatic psychology
  
• Sophia analysis
  
• Status dynamic psychotherapy
  
• Symbolic-Experiential Therapy
  
• Systematic desensitization
  
• Systematic Treatment Selection (STS)
  
• Systemic Constellations
  
• Systemic therapy
  

[edit]T

• T Groups
  
• Thought Field Therapy
  
• Transactional Analysis (TA)
  
• Transactional Psychotherapy (TP)
  
• Transference Focused Psychotherapy
  
• Transpersonal psychology
  
• Etiotropic Trauma Management (ETM)
  
• Traumatic Incident Reduction
  
• Twelve-step programs
  

[edit]U

• Unitive Psychotherapy
  

[edit]V

• Vegetotherapy
  

[edit]W

• Wilderness therapy
  

[edit]X

[edit]Y

[edit]Z

http://en.wikipedia.org/wiki/List_of_psychotherapies

List of therapies

Getting back erection for such a patient is called Penile Rehabilitation Therapy, PRT.

TREATMENT OPTIONS ARE

I
Giving daily medicines is one method of treatment hoping to bring recovery in the damaged smooth muscle tissue.
II
Giving medicine as required before sexual intercourse is another treatment option. Though both these methods, (1) giving medicines daily and (2) giving medicines only before sexual intercourse, not daily have been studied scientifically and debated hugely for the last 10 years, no definite conclusion is arrived about which is the better or correct method to lessen or reverse the damage caused by radical prostatectomy.

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What medicines have been used to treat Erectile Dysfunctions following radical prostatectomy?

[1] Oral PDE – 5 inhibitors medicines such as Sildenafil, Vardenafil, Tadalafil
[2] Intracavernous injection of Vaso Active Drugs (drugs like papaverine), ICIVAD.
[3] Intraurethral alprostadil administration MUSE

How was the treatment efficacy measured?

• IIEF-5 validated Questionnaire
• Rigiscan testing
• Nocturnal Penile Tumescence and Rigidity (NPTR) testing
• Percutaneous penile biopsies
• rat model to test
  • penile shaft collagen content
  • functional and histologic changes in the penis

Note
While there have been many studies in the rat model showing the benefits of local vasoactive therapies, the crossover to clinical significance in the human has been more difficult to prove.

Ideally the tests should be carried out before and after the surgical procedure.

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What is the mechanism of ED that follows RP?

• Primary Neurogenic Damage (Nerve Damage) (despite meticulous nerve sparing surgery)

  [3] Klien et al were the first to show (in rat model) nerve damage causes penile apoptosis (atrophy and fibrosis)
  [4] In 2003, User and McVary etal demonstrated this.

• Secondary Smooth muscle atrophy is the underlying cause of
  • penile atrophy,
  • veno-occlusive dysfunction, and
  • fibrosis.

First study showing benefit with ICIVAD came in 1997 from F. Montorsi, G. G. Luigi, L. F. Strambi, et al., [1]

By performing percutaneous penile biopsies at the time of RP and 6 months later, Schwartz et al. were the first to demonstrate that early use of 100 mg of sildenafil after RP may preserve intracorporeal smooth muscle content

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Mechanism: How PDE – 5 benefit in recovering penile tissue damage?

PDE-5 inhibitors promote penile rehabilitation by stimulating smooth muscle cell replacement via a cGMP mechanism and reducing collagen synthesis via phosphokinase G activation

Which is better regular daily vasoactive medicine or medicine on demand before sexual intercourse?

The benefits of regular daily PDE 5 over before Sexual Intercourse is not confirmed according to abstract presented at 2006 annual meeting [5] of the American Urological Association by the same Dr. Montorsi who in 1997 published first study on benefit of Intracorporal alprostadil Injection.
No significant difference was found in the mean IIEF score between patients treated with daily therapy versus on demand therapy.

[6] A. Bannowsky et al from Germany concluded in 2008 that in cases of early penile erection, daily low-dose sildenafil leads to a significant improvement in the recovery of erectile function.

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[7] Montorsi et al recently did the largest randomized, double-blind, double-dummy, multicenter, parallel study done to date. Montorsi et al. recently reported on a vardenafil trial after bilateral nerve-sparing RP that on demand dosing is more effective in improving both erectile function and sexual intercourse completion rates within this patient population prompts reconsideration of the current practice of prescribing nightly PDE 5 inhibitor therapy, as on demand use of vardenafil if equally effective in men with ED following NSRP.

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Interesting story

HOW MEDICAL RESEARCH IS DONE?

Medical Research is not a sacrosanct declaration by a God man to be followed without questioning for centuries.
Interestingly powerful arguments have been put forth concluding that damaged penis (chronic hypoxia = continued lack of oxygen and ischemia lack of blood supply) cannot be reversed. Abraham Morgentaler from Harvard University listed several intriguing arguments [8].

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WHY CLAIMS OF RESTORING TISSUE DAMAGE BY VASOACTIVE MEDICINES ARE INCORRECT

First, he questioned the theory that penile rehabilitation helps to reverse the chronic hypoxia and ischemia of the flaccid penis following RP.

“But why is there reason to suspect that the flaccid penis is hypoxic, despite having venous oxygen tension? After all, the endothelium of all venous structures suffers no ill effects despite a lifetime of exposure to oxygen levels that are well below those seen in arterial blood.

Second, there is no reason to believe that the penis is ischemic following RP. If it were ischemic, would it not eventually become necrotic?

Furthermore, PDE-5 inhibitors do not increase blood flow to the flaccid penis, so how can benefit occur?”

[9] In a more recent point-counterpoint debate at the 2008 AUA Annual Meeting in Orlando, Fla, Craig Donatucci from Duke University was charged with providing the contrary argument as whether penile rehabilitation was effective after RP.

Craig described the pitfalls of the clinical trials that have been presented thus far.

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WE CONCLUDE

with what CRAIG DONATUCCI from Duke University stated in 2008:
“There is not yet enough evidence to declare penile rehabilitation effective; but I am not sufficiently convinced of the ineffectiveness of penile rehabilitation to recommend against it. My opinion is that the benefits of penile rehabilitation are “not proven”; yet it is currently the standard of care”.

[10] This is a review of
Penile Rehabilitation Therapy with PDE-V Inhibitors Following Radical Prostatectomy: Proceed with Caution by
M. Eric Brewer Jr. and Edward D. Kim

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REFERENCES

[1]
F. Montorsi, G. G. Luigi, L. F. Strambi, et al., “Recovery of spontaneous erectile function after nervesparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial,”
The Journal of Urology, vol. 158, no. 4, pp. 1408–1410, 1997.

[2]
E. J. Schwartz, P. Wong, and R. J. Graydon, “Sildenafil preserves intracorporeal smooth muscle after radical retropubic prostatectomy,”
The Journal of Urology, vol. 171, no. 2, part 1, pp. 771–774, 2004.

[3]
L. T. Klein, M. I. Miller, R. Buttyan, et al., “Apoptosis in the rat penis after penile denervation,” The Journal of Urology, vol. 158, no. 2, pp. 626–630, 1997.

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[4]
H. M. User, J. H. Hairston, D. J. Zelner, K. E. McKenna, and K. T. McVary, “Penile weight and cell subtype specific changes in a post-radical prostatectomy model of erectile dysfunction,” The Journal of Urology, vol. 169, no. 3, pp. 1175–1179, 2003.

[5]
F. Montorsi, A. Salonia, A. Gallina, et al., “There is no significant difference between on-demand PDE5-I vs PDE5-I as rehabilitative treatment in patients treated by bilateral nerve-sparing radical prostatectomy,” The Journal of Urology, vol. 175, p. S225, 2006.

[6]
A. Bannowsky, H. Schulze, C. van der Horst, S. Hautmann, and K.-P. Jünemann, “Recovery of erectile function after nerve-sparing radical prostatectomy: improvement with nightly low-dose sildenafil,” BJU International, vol. 101, no. 10, pp. 1279–1283, 2008.

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[7]
F. Montorsi, G. Brock, J. Lee, et al., “Effect of nightly versus on-demand vardenafil on recovery of erectile function in men following bilateral nerve-sparing radical prostatectomy,” European Urology, vol. 54, no. 4, pp. 924–931, 2008.

[8]
J. P. Mulhall and A. Morgentaler, “Penile rehabilitation should become the norm for radical prostatectomy patients,” The Journal of Sexual Medicine, vol. 4, no. 3, pp. 538–543, 2007.

[9]

J. P. Mulhall and C. Donatucci, “Is penile rehabilitation effective in improving erectile function after radical prostatectomy? Point-counterpoint debate,” in Proceedings of the American Urological Association Annual Meeting, Orlando, Fla, USA, May 2008.

[10]
Advances in Urology
Volume 2009 (2009), Article ID 852437, 4 pages
doi:10.1155/2009/852437

Review Article
Penile Rehabilitation Therapy with PDE-V Inhibitors Following Radical Prostatectomy: Proceed with Caution
M. Eric Brewer Jr. and Edward D. Kim
Graduate School of Medicine,
The University of Tennessee, Knoxville, TN 37920, USA

Received 19 June 2008; Revised 20 October 2008; Accepted 15 December 2008

Recommended by David F. Penson
Advances in Urology, vol. 2009, Article ID 852437, 4 pages, 2009. doi:10.1155/2009/852437

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