Selected Non-Moderated Posters

Selected Non-moderated Posters

\' ASECOMY llEHA \'!ORAL EFFECTS IN MEN Authors: T. Bandel; R. Bauer; T. Sigerson. Bayer AG., Wuppertal, Germany Aragao, A J, Rodrigues A 0., Agostinho AG., Juliano, RV. \1arinc!li CM., Affiliation: Pharmacology, Bayer AG, Wuppertal, Germany Wroclavski, ER., Bozzo, I.S Objective: Evaluate the satisfaction degree and the behavioral effecb or vasectomy in the couple and in the man in matter VARDENAFIL'S IMPROVEMENT ON THE QUALITY OF ERECTIONS CAN BE Method There were selected 113 men submit1ed to sterilization by vasectomy, in DEMONSTRATED EARLY IN RIGfSCAN™ STUDIES. the period from January of 1996 to January of 1999, after approval of the Ethics ·commission of Family Planning Service from the Faculdadc de Medicina do ABC. A.JI the patients were called b~· Introduction and Objectives letter. telegram or phone calls, in a spontaneous way and not obligatory A di red questionnaire Vardenafil is a new highly selective PDE5 inhibitor that is being developed for treatment of \Vas used approaching the following: self-esteem aspects, orgasm corHroL sexual satisfaction, erectile dysfunction. ln two Phase Ila studies with patients with mild to moderate erectile complications, sexual habit and masturbation dysfunction, Rigiscan™ measurements of quality of erections were determined. The objective Results: 23,5% of the patients told that, the sexual relationship performance got of this retrospective analysis was to compare the effect ofvardcnafil on the strength of better and 71% didn't notice difference, 5,9% thought worst. Testicular pain was told in 17,6% erections that first occurred in a visual sexual stimulation period betw-een 20 min and 40 min and 5,9% pain at ejaculation. There were no regret and all would recommend it to a friend They after dosing didn't tell change of behavior with masturbation, premature ejaculation or libido in relation to pre vasectomy lime Materials and Methods · Conclusion: The vasectomy has high acceptance level and therefore lower regret 1n ffi·o different studies, patients with demonstrated erectile dysfunction for at least 6 months, level among selected couples. There is little alteration in the sexual behavior, however arrounds ¼ received either placebo, IO mg and 20 mg vardenafil or placebo 20 mg and 40 mg vardenafil of the males tell improvement in the pcrtOnnancc maybe because the decrease in the sexual act as a single oral dose in a randomized, double-blinded, three-way crossover design. Erectile anxiety and the partner's larger receptivity for the safety of the undcsircble pregnancy quality was determined with Rigiscan™ measurements. The primary outcome was the Key Words: Vasectomy, behavior duration of rigidity in excess of 60% for erections that were initiated by watching an erotic video tape starting 20 minutes after dosing for a 20 minute period. Patients repeated the video sessions two more times but, for this analysis, only erections that occurred in the first video session were analyzed. The treatment effect was evaluated statistically using ANOV A Results From each study, 21 patients were valid for efficacy evaluation. Erections generally started at or soon after the initiation of the video at 20 minutes after dosing. The mean duration of these erections, originating in the first video session, with greater than 60% rigidity at the base of the penis of patients on 40 mg was 26.0 minutes longer than those on placebo (p - 0.002). On 20 mg they were 16.3 minutes (p - 0.05) and 15.0 minutes (JF0.038) longer for the two separate studies. For the IO mg dose, there was no difference in activity from placebo at this early time point although significant differences were seen for this dose for the study as a whole. Significant differences were also seen for Tumescence Activity Units and Rigidity Activity Units for doses of20 and 40 mg.

Conclusions This study demonstrates an early effect of vardenafil on improvement of erectile quality with both 20 mg (repeatable in two studies) and 40 mg doses. These results imply a fast onset of action for vardenafil, however specifically designed trials are needed to determine the earliest time of effect. Selected Non-moderated Posters

S18 34

The use of Sodium Nitroprusside (SN) in the pharmacologically induced V ASOACTIVE DRUGS . INTRACAVERNOSAL(IC) AND ORAL(OR) erection - A prospective study in 25 patients ADMINISTRATION IN THE MALE ERECTILE DYSFUNCTION (MED)

Walter J. Bestane, Mauricio C. Bestane, Ney Anderson Ramos Brito Cunha, P.R. ; ANDROCLOOCA; Rio de Janeiro; Brazil. Hospital Ana Costa- Santos, SP, Brasil Objective : Compare erectile responses between OR and IC administration . Material and Methods : Among 94 users of OR (29-82, average 55 years Purpose: The pharmacologically induced erection by self-injection therapy of age) and among 197 users of!C (33-83, average 59 years) we analiz.ed 63 is a world-wide accepted treatment for the erectile dysfunction. Tue patients whom, regardless of cause connections and MED degree , took tests Prostaglandin E1 (PGE1) or the combination of PGE1 and other drugs are 1he or make use of both alternatives in order to evaluate the sufficiency of their most widely-used vasoactive drugs for erection therapy. The Sodium erectile responses, in sight of the classical definition of the ISIR for MED Nitroprusside (SN), a strong vasoactive agent due to 1he Nitric Oxide (November, 7 , I 996 - "the consistent inability of a man to attain and maintain liberation, has been used with variable results in doses up to 940 mcg. The an erection of sufficient rigidity to permit satisfactory sexual intercourse").For purpose of this paper is to check the efficacy and safety of the Sodium OR , we used 50 mg of sildenafil citrate . For IC , we used a trimix solution with 1,25 µg ofPGE (alprostadil), 2 mg of PAP (cloridrate ofpapaverine) Nitroprusside in the pharmacologically induced erection. and 0,1 mg ofChlorpromazine(CLPZ). Patients and Methods; 25 patients with erectile dysfunction who had Results : Fifty-seven users (90%) of IC, and forty-five users (71.4%) of experienced intracavernous pharmacotherapy with a mixture of PGE1, OR considered the erection satisfactory. Six users of!C (10%)), and 18 users Papaverine and Clorpromazine for at least 3 months were evaluated. Under a of OR (28,6%) considered the erection unsatisfactory. signed consent, they were asked to use in at least two opportunities the self All 45 patients satisfied with OR administration state that the erectile injecton ofNitroprusside I mg. response with IC administration is superior , especially in the maintenance A total of22 patients completed the standardized protocol and Results: were aspect. In this same group , 55% (25) prefer IC administration and, in asked fill in a questionnaire comparing the response of the to drugs used. general, make use of OR administration at random meetings, trips, etc.; 45% Although erectile response to NS was statistically significant weaker (20) are completely satisfied with OR and do not use IC , for various reasons. compared to PGE1 mixture (p=0,007), 8 patients (36%) decided to continue Among the 18 pacients that do not respond to OR administration, 66,6% the use of it, IO patients returned to the PGE1 mixture injection and the other 4 (12) consider the erectile response satisfactory with IC , and 33,4% do not. patients were not quite sure about the best result. Painful erection was reported These 33,4% ( 6 patients), are the same patients in the 10% group (6 in 63 ), as mild in both treatments. Two out of eight patients who continued the use of equally not satisfied with IC administration . NS, reported that in spite of its weaker effect, the erection induced by this Conclusion : IC administration is still. a very effective method to best drug seemed to be more natural, occurring a new erection if they were evaluate / treat the MED . Mainly in patients who do not respond well to stimulated again. No side effects were reported by any patient. sildenafil. The method bas the potential to rescue a considerable number of Conclusions: Being a low cost, safety and effective drug that doesn't such patients , possibly preventing them from dropping the treatment and/or demand refrigeration to stock, the authors recommend it's use as an alternative delaying a penile implant . in 1he pharmacologically induced erection. KEY WORDS:erectile dysfunction ; intracavernosal administration ; vasoactive drugs .

SERIC FREE TESTOSTERONE AND TOTAL TESTSOTERONE TREATMENT OF THE PEYRONIE'S DISEASE WITH VERAPAMILO RELATED TO LOW LIBIDO IN MALE PATIENTS WITH SEXUAL DYSFUNCTION. INTRALESIONAL: Preliminary results Di Capua T., Szemat R.; Contreras Y., Marin™, Sucre T., Palomino C., Garcia Casabe A.; Roletto, L.; Cobreros, C.; Bechara, A.; Fredotovich, N. F., Pino J., Dieguez V., Garcia M., Jaimes JC., Palacios R., Valera V., Becerra S. Hospital “Dr. Domingo Luciani”~, Caracas, Venezuela Hospital Durand- Division of Urology- Surgery's Department Objective: to determine the relationship between the low sexual desire and the IME- Instituto Medico Especializado - Buenos Aires- Argentina seric free testosterone vs. total testosterone levels in patients consulting for sexual dysfunction Objective: Evaluate the clinical modifications of the Peyronie's Disease at its Materials and Methods. out of 717 patients evaluated for male se:-..ual dysfunction initials states (immature plaques), with the administration of 10 mg. (MSD), we identified 148 patients \1/1th low lihido, and reviewed both the total testosterone level a intraplaque ofVerapamilo. the free testosterone level. We classified the testosterone levels in quartiles and considered as low levels those in the first and below the first quartile Material and Methods: From April of 1999 to March of 2001 (24 months), Results: Of these 148 patients, only 20 (13,5%} had come for low desire as the 24 patients, with a mean age of 53.1 years (range 40 to 70) had received IO initial complaint; Sg<'/4 came for erectile dysfunction (ED), and 12% came for premature ejaeulatim mg of Verapamilo intralesional once every 15 days for 6 months (completing (PE). The total testosterone was detennined only in 70 patients, and the free testosterone in 31 12 sessions) using a syringe of l O ml and a 25 G needle under local Both parameters were determined in only 13 patients at the same time. Free testosterone was low anaesthesia Some of the patients are still under treatment The mean period of in 65% of patients with this result determined. Total testosterone was low in 58% of patients with there initial signal sintomatology, at the time they were include in protocol this result. Out of the 13 patients with both parameters, they were coincident in 9 cases and dissimilar in 4, 2 up and 2 down for each parameter among each other was 7.5 months. Conclusions: it is useful to have a determination of testosterone in evaluating Pre and post evaluation studies included: ultrasonography (to measure the male patients with sexual dysfunction, specially in those with low libido, as an important lesion), IC injection and photos (to objectify the curve), International Index of proportion of them will show to have low values. However, it seems somehow difficult to favor in Erectil Function (IIEF 5) and the analogical visual scale to determine the pain one of either free or total testosterone determination. We suggest to determined both parameters. and the degree ofunsatisfaction with the symptoms. At the end of the study all It is also important to ask patients about desire. since many of them would not refer it as a complaint patients were ask to respond a question of global satisfaction (QGS). Key words: free testosterone, total testosterone, libido We excluded patients with signs or symptoms of mature plaques (unpainfull, stable or with calcification). Result: Of the 24 patients, 9 had completed treatment (37.5%), 14 are still in protocol (58%) and only I patient gave up. 6/9 patients that had finished the treatment (67%) expressed a significant relieve in there symptoms (QGS). The objective evaluation of response to the verapamilo intralesional showed: a favorable change on the curvature 4/8 (50%), unpainfull 4/5 (80%), reduction of the plaque 3/9 (33.5%), and an improved of the sexual potential 2/2 (100%). Equimosis in the site of the injection had been observed. Conclusions: In our series the verapamilo intralesional its an effective an safety alternative subjective as objectively to improve the symptoms of the Peyronie's diseases in its initial states. More patients an long term follow up will be necessary to confirm our preliminary results. Key words: Peyronie disease - Verapamilo

International Journal of Impotence Research Selected Non-moderated Posters

S19 78

INCIDENCE OF PEYRONIE'S DISEASE fNTRACA VERNOUS INJECTION fN THE TREATMENT OF POST IN PATIENTS RADICAL PROSTATECTOMY ERECTILE DYSFUNCTION: A LONG TERM FOLLOW-UP WITH ERECTILE DYSFUNCTION Claro, J;Aboim, E; Andrade, E; Nardozza Jr, A; Srougi, M. Unifesp - EPM, Sao Paulo, Brazil Objective. Evaluate the efficacy and side effects ofself-injeclion lherapy in patients Chaves, O.H.T; Cunha, A.P.L; Ramalho, F.A.P; Carvalho, with erectile dysfunction (ED) secondary to radical prostatectomy during 96 months F. L. Material and Methods: 168 patients with ED (aged 43 to 78 years old)submitted to Hospital radical retropubic prostatectomy due to localized prostate cancer, were treated with self-injection IUniversitario Sao Jose - Faculdade de therapy using papavcrine, phentolamine and prostaglandin El, at home Ciencias Medicas de Minas Gerais, E1elo Horizonte - Results:This study showed a 94.6% success rate, with no life-threating Brasil-MG complications. Besides, our series presented a 13. I% cure rate with this therapy Conclusions: Self-injection therapy with papaverine, phentolarnine and prostaglandin El is effective and safe in the treatment of ED after radical prostatectomy INTRODUCTION: Peyronie's disease is a clinical problem of the KEY WORDS:Prostate cancer.Erectile dysfunction. Self-injection therapy. Radical penis that affects mainly middle-aged men and which causes remain prostatectomy. obscure. We analyse the incidence of this condition in patients with erectile dysfunction.

MATERtALS AN9 ~.992 and 2001, a total of 761 patients with erectile dysfunction were studied. They were submitted to and interview and a physical examination with special attention to the presence of fibrotic plaques involving !tie cavernous tissue and curvature or defonnation of the penis.

RESULTS: Of the 761 patients with erectile dysfunction, 32 (4.2%) had Peyronie's disease.

CONCLUSION: The incidence of Peyronie's disease in patients with erectile disfunction (4.2%) is superior to that of middle-aged men without this sexual dysfunction (0.06%) because the penile defonnity of Peyronie's disease may cause erectile dysfunction. Keywords: Peyronie's disease. Erectile dysfunction.

910

PENILE PROSTHESIS IN CASES OF FIBROSIS OF CORPORA Serum hormone levels, anxiety and depression in renal transplant CAVERNOSA patients with erectile dysfunction. Favela Camacho, .T.R; Sotomayor de Zavaleta, M; Arcila, D; Faria, G. E. Objective: to evaluate the erectile function in patients with terminal renal insufficiency submitted to renal transplant, in order to find a Institnto de Urologia e Nefrologia de Rio Claro, Rio Claro, SP, Brazil relationship between the serum LH, FSH, testosterone and prolactine and their psychological status. and erectile function. Objective: One of the biggest difficulties that professionals dedicated to Material and methods: we undertook a prospective study with 7 males the treatment of erectile dysfunction face these days is related to the submitted to renal transplant between January and December of 2000. The implarlt of penile prosthesis in patients with erectile dysfunction as result patients answered the IIEF questionnaire, an anxiety and depression scale of a generalized fibrosis of the corpora cavemosa. This clinical condition during their hospital stay, serum hormonal levels (testosterone, prolactine, is more commonly seen in men who have presented priapism during FSH and LH) as well as all their clinical history before and three months several hours or extensive inflammation of the corpora cavemosa as a after the renal transplant. result of previous after-surgery infections. Under these circumstances, the Results: the patients average age was 32 years (with ranges from 16 to implant of new prosthesis is extremely difficult due to the impossibility or 56), out of which, 71.3% had erectile dysfunction before the renal difficulty of achieving conventional dilation of the cavernous tissues. transplant, (28.5% mild and 42.8% severe) and 85% after the transplant (two patients had an increase in their erectile dysfunction). We found an Material and Methods: The author presents the long-term results of a increase in their anxiety level in 42% of patients and no depression before surgical technique, which consists of completely removing the corporeal surgery, returning to normal after the transplant in all patients, with out fibrosis contained in the tunica albuginea and implanting a semi-rigid any influence in their erectile dysfunction. prosthesis. Testosterone serum levels were abnormal in 57% of patients pre-transplant (lower in 42% and elevated in 14%) with the normalization after surgery Results: From March 1988 to December 1999, 14 patients underwent except in one patient who persisted with low levels. All patients had surgery. 9 of them presented good functional and aesthetic results. 2 normal FSH levels before the transplant with an increase within normal patients developed necrosis of the albuginea and of the skin up to the range in 28.5%. Concerning the LH levels, they remained normal before corona causing one of them to have the prosthesis removed. 3 patients and after surgery. Prolactine levels were increased before the transplant needed to have their implants removed due to after-surgery infection. with a return to normal three months after surgery. Conclusions: Erectile dysfunction has a high incidence in patients with Conclusion: The author preconizes this technique as the best option in terminal chronic renal insufficiency, with an increased incidence after prosthesis implant in patients with generalized fibrosis of the corpora renal transplant. We did not fmd any relationship between their hormone cavemosa whenever it is not possible to achieve dilation with special serum levels, anxiety and depression dilators. levels in relation to erectile dysfunction. Key words: renal transplant, erectile dysfunction. Key Words: Penile prosthesis, impotence, penis.

International Journal of Impotence Research Selected Non-moderated Posters

S20 11 12

TESTOSTERONE ESTERS COMBINATION IN ENDOCRINOGENIC MA ERECTILE DISFUNCTION AND PSYCHOPATHOLOGY SEXUAL DYSFUNCTION Grassi, M.V.F.C. Glina S. & Pagani E. Dept Medical Psychology and Psychiatry - Unicamp - SP - Brazil lnstituto H. Ellis, Sao Paulo, Brazil Doctorate Research in Mental Health - Financed by Fapesp Objective: To access the testosterone esters efficacy Objective: Study psychopathologicals aspects in the subjects with symptoms in the treatment of "pure" endocrinogenic male sexual dysfunction. of psychogenic erectile disfunction (psychoanalytical perspective). Methods: Twenty-four male patients complaining on sexual dysfunction Methods: Evaluation and psychotherapy treatment (followed up of two aged from 18 to 72 years, with low free and/or total serum testosterone years) for 25 men with diagnostic of psychogenic erectile dysfunction levels and without any physic or laboratory evidence of arterial, in veno-occlusive or neural impairments, were ~ubmitted to a treatment of Urology and Psychiatry Ambulatories - Unicamp (1998/2000). intramuscular injections of a combination of four testosterone esters, Resu_Its: Masculinity, as a symptom, may use the erect penis activity as an repeated three times every three weeks. Each injection included the unagmary mamtenance banner of the phalical potency. following esters: propionate 30mg, phenylpropionate 60 mg, Conclusion: The installation of the erectile disfunction (which affects the caproate 100 mg, isocaproate 60 mg. The patients were reevaluated organ) raises the issue of masculinity (which affects the being itself), thus one week after the last injection aiming to access the treatment efficacy. confirming the subjective sensation of sexual "impotence" - masculine Treatment were considered effective if patie11t said the the symptompm subject and symptom fall in the erective failure. had disappeared. At that time all patients had serum total and free Keywords: Erectile disfunction. Psychopathology. Psychoanalysis. testosterone levels within normal range. Results: Are displayed at the table bellow.

Total Effective Ineffective Erectile dysfunction 12 5(42%) 7(58%) Premature ejaculation 4 1(25%) 3(75%) Sexual desire inhibition 8 5(63%) 3(37%) Total 24 11(46%) 13(54%)

Discussion: The treatment proposed consisted of a c combination of low, middle and long lasting testosterone esters for a period of about 2,5 months. Our results show that the majority of the patients supposed to have pure endocrinogenic sexual dysfunction did not respond to hormonal replacement.Nevertheless, patients whose main complaint was decrease of sexual desire responded better than the other groups.

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CREATION OF AN AMBULATORY OF ANDROLOGY FOR THE A POPULATION STUDY OF 200 PATIENTS IN THE REGION OF TREATMENT OF ERECTILE DYSFUNCTION IN A PUBLIC HOSPITAL SOROCABA-SP. Messina L.E;Messina,M.CM S,Duque,l.L;Munhoz,F;Pere1ra,D.A,SilvaJr,E.B; Messina,L.E;Messina,M.C.M.S;Duque,J.L;Munhoz,F;Pereira,D.A;SilvaJr,E.B; Gun.S. Gun,S. Centro de Ciencias Med,cas c Biol6g1cas da Pont1fic1a Urnvers,dade Cat6hca Centro de Ciencias Medicas e Biologicas da Pontificia Universidade Cat6lica de Sao Paulo - ConJunto Hosp1talar de Sorocaba de Sao Paulo - Conjunto Hospitalar de Sorocaba Objectives: To create an andrology ambulatory to see patients with erectile Introduction: erectile dysfunction is defined as the inability to achieve orkeep dysfunction in our institution. an erection in order to have a satisfactory sexual intercourse. It's known that llfaterial and Methods: To elaborate a protocol with several queries which wil erectile dysfunction affects 10% of the male population during lifetime. Some be filled out by the patients in the first time when they consult an urologist. In diseases like diabetes, hypertension, cigarette smoking, alcohol abuse, and this questionnaire, the questions basically analyze 1) Identification; 2)problem hormonal changes are risk factors for ED. origin, which is told by the patient; 3) information about qualityof erection; Material and Methods: Two hundred patients with erectile dysfunction were 4) sexual partner behavior; 5) medical history, 6) previoustreatrnents; 7) voidin! analyzed by the andrologist. In the first consultation, the patients answered a pattern; 8) habits; 9) physical examination; 10) blood and urine tests and PSA specific questionnaire developed by our group. Patients then underwen physical for patients older than 45 yo. After tests, the patients are seen by the urologist examination and blood tests such as creatinine, urea, prolactin, testosterone, and for the second time, and tests results are analyzed. The patients then undergo serum glucose. In the second consultation, patients underwent an erection test intracavemosal injection of 10 mcg ofE2 Prostaglandin bought by the patient. (intracavemosal injection of l O mcg of prostaglandin). Results: two hundred patients with different degrees of erectile dysfunction Results: Two hundred patients with a mean age of 51.3 years (ranging from agreed to participate of th.is study in the public health system in the region of 18 to 79 yo) were analyzed. We found the following: diabetes in 23,25% of the Sorocaba city. 40,60% of the patients had psychogenic ED, 31, 10% had patients, hypertension in 23,80%; hormonal alteration in 10,91 %; cigarette organic causes, and 26,19% had both, smoking in 33,43% and alcohol abuse in 41,41%. Ccmclusions: The protocol elaborat.ed by our group showed good results, evell Cooclusions: erectile dysfunction is directly related to age, but some in a public institution, with different urologists involved. The method of associated diseases c.cm anticipate the clinical features of ED. Yet, if the patient attendance based on the questionnaire allows us to staodanlize the medical is aware of his problem with ED and the consequences ofthis disease in the histmy and physical examination and facilitates the diagnosis and data quality of sexual life, he is stimulated to better control the associated diseases collection. The psychological evaluation, when necessary, is done outside and bad habits (alcoholism and cigarette smoking). We believe ifwe focus o.n the institution, which leads 62% ofthe patients to abandon the treatment. those parameters, 1/4 of organic ED may be avoided or delayed. In regard to Key Words: Erectile dysfunction. Andrology ambulatory. those l 0,91 % of patients who had hormonal alterations,o.nly l % wer significant and needed treatment. Key Words: Erectile dysfunction. Diabetes. Hypertension.

International Journal of Impotence Research Selected Non-moderated Posters

S21 15 16

PENILE ANTHROPOLOGY IN THE CHILEAN PENILE PROSTHESIS SURGERY UNDER LOCAL ANAESTHESIA POPULATION Schaal, C.H.; Costa, R.P. PINO A E; SEPULVEDA, E. OBJECTIVE: To evaluate the effectiveness and patient tolerance to local penile block anaesthesia for one body penile prosthesis implantation. Universidad de Santiago de Chile. Clinica MATERIAL AND METHODS: We made a prospective evaluation of the Androsex. patient tolerance for one body penile prosthesis implantation using a Objectives: To evaluate the size of the penis in the subcutaneous penile ring infiltration at the level of the penile root, plus a direct Chilean population, and to relate it to the height and corporal injection of local anaesthetic agent. Pain control during the procedure the size of feet, hands and nose. was assessed using a l 0-point linear analog pain scale and questionare. Material and Method: 200 patients consulting RES UL TS: A total of 34 patients recived the penile block anaesthesia, whithoul sedation. No adverse events was encountered. Median pain score was regarding Erectile Dysfunction, with an erection 2 ( range I to 3 ). The overall satisfaction with the anaesthesia was: very induced by intracavemous Prostaglandin El, had satisfactory in 82,3%; satisfactory in 17,7%; insatisfactory and very their penises measured in full erection, from the insatisfactory in 0%. pubic bone and from the pubic-penile angle, the CONCLUSION: The technic of local anaesthesia employed in this series was circumference and diameter in the middle third, the very simply, effective, safe and satisfactory for implant of one body prosthesis. nose from the base of the nasal wing to the point, KEY WORDS: Erectyle dysfunction, Penile prosthesis, Local anaesthesia. the hand stretched out and open and the shoe size. Results: The age range of the patients in the study was from 19 to 74 years, x 44 years, height range 1.60 - 1.91 m, x 1.72 m, penile length range 7.5 - 20 cm, x = 13.56 cm, penile diameter range 3 - 5.5 cm, x 3. 98 cm, circumference range 9 - 17 cm, x 12. 75 cm, shoe range N° 39 - 45, x 40.5, nose range 3 - 5.5 cm, x 3.4, stretched out hand range 17 - 23 cm, x 18.45, open hand range 18- 23.5, x 19.5. There was no statistic relationship between the size of the penis and the other variables. Conclusion: This study allows us to de-mystify the popular beliefs which relate the height, the size of the hands, feet and nose with the size of the penis. Key Words: Size of the penis, Penile Anthropometry.

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LIBERATED WOMEN x DYSFUNCTION SEXUAL x PLEASURE MALE SEXUAL BEHAVIOR ChcrmanK.S. AGE GROUPS AND THEIR DIFFERENCES x PLEASURE. Objective:_ Helping the women of today who suffer from overload syndrome to Chcrman S.K.. assume the rights and responsibilities of their own sexual pleasure, reducing Objective:_ Enabling the current man, and this is independent of his age group, conflicts and symptoms such as frigidity, anorgasmy and pain during sex, to fully exercise his sexuality, reducing and even eliminating the risk of dispareunia. impotency. The biggest sexual worry of today's men is related to his erection, its Material and Method: Data obtained during 24 years of both private and public emergence, the duration before and during penetration. There is a way to clinical experience while treating 3, 290 women who were teenagers and moved substitute current sex, a factory of conflicts, transforming it into an encounter on to be adults, mature women and then into menopause. The method consisted between health and pleasure. of anarnnesis and specific questionnaires. The treatment included sexual Material and Method:. The survey was taken among 719 patients whose reeducation, changing of inhibitions, guilt and shame to new options, being complaints were: Sexual Impotency: 520 cases (72%) and Untimely Ejaculation: responsible for your body as well as your pleasure, for example: the practice of 199 cases (28%). The method used on these 719 patients was a standard 19-point masturbation. Here, 7 taboos were broken because they were false and 14 questionnaire which referred to: sexual performance versus age. The following advantages were demonstrated to those who practiced it. In general, I offer a list criteria were created: Age Group-division: Adolescents: puberty to 18 years - 50 of 19 basic behavioral ideas, correct procedures in relation to reaching sexual cases (7%). Adult youths: 18 to 25 years old -122 cases (17%). Adults: 25 to 40 affection and the building of self-confidence. In relation lo the 'liberated years old - 223 cases (3 I%). Mature Adults: 40 to 65 years old - 310 cases woman', here is a questionnaire of IO items which define her. (43%). Over 65 years of age 14 cases (2%). The criteria for evaluation were: Results:_The most serious sexual conflicts found to end up in dysfunction are: Very Important, Important, A Little Important, No Importance, Yes, No and I what is it to be a 'liberated' woman, the rights to or not to masturbate, sexual have never thought about this. fantasy, reaching orgasm, 'power' relationships in and outside the sexual Results:_Common fmdings in all age groups. Among the 520 impotent (72%) scenario. With this kind of reeducation, they overcome behavioral doubts, 450 of them showed the first sign upon having untimely ejaculation. In 2 acts, symptoms such as frigidity, anorgasmy and pain during sex. solitary masturbation and oral sex, they don't worry about the emergence and Conclusion:_After working for 25 years treating women, men and couples, I sustaining of their erection until they have an orgasm. Only those above 65 years have concluded that there aren't liberated women but only the current of age show this preoccupation. The rest showed some variations, especially economically free woman. It is so because all of them wish to have a partner to among adolescents, mature adults and the old. share with. Finally, the current woman, from the time she is an adolescent, Conclusion: When it comes to sex, current man, independent of his age, should understand that this struggle, sexual reeducation, the search for feminine oscillates like a pendulum between macho archaic behavior and the absence of identity starts inside her and is won in this way too. 'Seeing that I am the owner parameters that give back to him the . old security of being macho and this ofmy body, no one has more rights than I over my sexuality than I myself' Upon attitude is before going into the sexual scenario as well as also upon doing so. reaching this state, she feels healthier, more capable, more secure, and better Age doeso 't have any importance when it comes to helping him change obsolete disposed to face and overcome the various difficulties in her daily life. sexual standards, showing him that these only contribute to creating conflicts, Key Words:_Sexual Dysfunction x Women. sexual dysfunction and ending up impotent. Sex, independent of the age, has to be a segment of life in which the practicing man acquires health, pleasure, relaxation and simultaneously reinvigorates himself socially thus supplying him with the means to face the adversities of his daily life. Key Words:_Age x Sexual Behavior.

International Journal of Impotence Research