I am constantly amazed at the role of luck (and an astute observer) in scientific advancement. You will be surprised how researchers discovered nitroglycerin, an important coronary artery disease management drug.

I’ll explore the remarkable nitrate discovery story. Then, I look forward to examining the contributions of Dr. Murad. We’ll end with five top tips for reducing your chances of suffering from cardiovascular disease.

“Diseases desperate grown,
By desperate appliance are relieved,
Or not at all.”

― William Shakespeare, Hamlet

Museums and Medicine

You might wonder why I notice connections such as heart medicines and dynamite.

My dear mother had something to do with my inclinations. When I was young, she took me to a museum every month. New York’s Museum of Modern Art, the Metropolitan Museum of Art, and the Yale Gallery.

When I visited New York last week, my first destination? The Whitney Museum in Manhattan’s Meatpacking District.

Why do I bring this up? My former school, Yale School of Medicine (USA), has an observational skills training workshop for first-year medical students.

The workshop is an exercise in visual training that allows students to look at something foreign to them early in their medical careers ‒for instance, an 18th-century British painting‒and extract the relevant information.

Why Yale Medical Students Go to a Museum

Here’s course creator Irwin M. Braverman, M.D. ’55, professor emeritus of dermatology:

“[Looking at art works] is a far cry from what we had,” said Braverman, recalling his medical education. “We were taught to look for patterns that were already known to exist.”

Shadows on an X-ray are this kind of problem. But what happens when a doctor encounters a situation they were not exposed to in medical school? They have no pattern on which to fall back.

According to Braverman, it takes about ten years to develop the skills to solve medical puzzles, and he wanted to give his students a head start.

“In essence, [examining art] is a physical examination of a patient,” said Braverman. The exhibit hall is the examination room, and the painting becomes the patient.

You Should Consider Going to a Museum

Examining great works of art teaches us observational skills. At Yale, students have 15 minutes to observe an assigned painting individually and gather as much detail as possible.

Based on their observations, the medical students discuss what may occur in each painting as a group.

Braverman explains that 18th- and 19th-century British paintings are perfect for this exercise because many offer stories about a real historical event. However, similar to patients with unexplained symptoms, they often contain ambiguous or contradictory information.

Trekking to your local museum or gallery might improve your observational skills.

Looking at paintings, sculptures, and performance art slows me down. It forces me to stand (or sit, a phenomenon more necessary as I age) and observe.

This year, for the first time, Braverman replaced the standard post-workshop evaluation with a specific question: what have you learned about yourself as an observer?

Nearly every medical student explained that, though they considered themselves adequate observers before the art workshop, they realized they previously looked at things superficially.

The course helped them learn to look at the world and their patients more in-depth.

Finally, I think of my museum times as ones of mindfulness. (And, it’s easier than vinyasa flow yoga for me.)

The Remarkable Discovery of Nitroglycerin

Have you heard of nitroglycerin? Nitroglycerin prevents angina (chest pain) caused by coronary artery disease.

This medicine is also used to relieve an angina attack that is already occurring.

Nitroglycerin belongs to a class of drugs known as nitrates. Angina happens when the heart muscle is not getting enough blood.

The drug works by relaxing and widening blood vessels to allow blood to flow more easily to the heart. Nitroglycerin will not relieve chest pain once it occurs.

It is also not intended to be taken just before physical activities (such as exercise or sexual activity) to prevent chest pain. Other medications may be needed in these situations.

The Nobel Prize

What do you think of when I mention Aldred Nobel? My mind immediately goes to the Nobel Prize.

I’m speechless! — Maria Ressa’s reaction when Olav Njølstad, Secretary of the Norwegian Nobel Committee, awarded her the 2021 Nobel Peace Prize for her “efforts to safeguard freedom of expression, which is a precondition for democracy and lasting peace.”

For over a century, Nobel Prizes have recognized extraordinary human achievements, ranging from literature to science.

The Nobel Prize is gifted “to the person who shall have done the most or the best work for fraternity between nations, the abolition or reduction of standing armies and for the holding and promotion of peace congresses,” according to the last will of founder Alfred Nobel.

The 2023 Nobel Prize announcements will occur from October 2nd through the 9th.

Alfred Nobel, Dynamite, and More

But our tale has a dark side, including death and mayhem. Let me back up a bit to talk about Alfred Nobel’s father.

Immanuel Nobel created the first truly usable sea mines on behalf of the Russian Czar. This development occurred in the mid-19th century during the Crimean War.

Alfred Nobel developed dynamite. He did not plan on its being used in war. Of course, you know the rest of the story.

Dynamite was soon used in the Franco-Prussian War. The Prussians used it first, followed by the French.

Alfred Nobel, Merchant of Death?

While many associate Nobel with pacificism, whether he approved dynamite’s military use is unclear.

In 1888, Alfred Nobel’s brother Ludvig died. A journalist erred and printed Alfred’s obituary. The piece scorned the living brother as a man who made millions through the deaths of others.

A French newspaper wrote, “Le marchand de la mort est mort,” or “The merchant of death is dead.” The obituary described Nobel as a man “who became rich by finding ways to kill more people faster than ever before.”

Stunned by what he read, Nobel was determined to improve his legacy. One year before he died in 1896, Nobel signed his last will, which set aside most of his vast estate to establish the five Nobel Prizes, including one awarded for pursuing peace.

Nitroglycerin Discovery

Let’s return to the strange story of heart and erectile dysfunction medicines. First, did you know that nitrate medications can trigger airport bomb detection scanners?

Nitrate-containing drugs also get the attention of explosive-sniffing dogs, a reminder of the origins of this extremely useful medication.

Ascanio Sobrero in Turin discovered nitroglycerin in 1847, following work with Theophile-Jules Pelouze.

Alfred Nobel joined Pelouze in 1851 and recognized the potential of nitroglycerin. Nobel began manufacturing the substance in Sweden, overcoming handling problems with his patent detonator.

Interestingly, Nobel suffered acutely from angina (chest pain) and refused nitroglycerin as a treatment.

Nitroglycerin in Medicine: Innovation from Tragedy

Today, nitroglycerin is a drug that dilates blood vessels.

The potent medicine is typically administered under the tongue to relieve and prevent angina (chest pain caused by reduced blood flow to the heart) attacks.

Dr. Ferid (“Fred”) Murad (1936–2023), a pharmacologist who shared a Nobel Prize in 1998 for discovering nitric oxide — an air pollutant and byproduct of nitroglycerin— played a key role in relaxing blood vessels.

Dr. Murad’s discovery dates to the 1970s, when he began studying nitroglycerin, the substance that Alfred Nobel, the namesake of the annual awards given in medicine and other disciplines, used to invent dynamite in 1867.

Our story of nitroglycerin as a medicine goes back to the 1900s. Alfred Nobel’s factory workers noticed a curious side effect of the explosive substance.

The workers’ labor-induced chest pains disappeared when they inhaled nitroglycerin fumes inside the factory. Soon, doctors began trying it to remedy angina, high blood pressure, and other cardiovascular disorders.

Nitroglycerin became a common treatment for heart problems, but until Dr. Murad began studying it at the University of Virginia (USA), nobody understood how it worked.

Through elegant experiments, Dr. Murad discovered that nitroglycerin releases nitric oxide, which relaxes smooth muscle cells.

Nitric Oxide and Male Erectile Dysfunction

Dr. Murad’s discovery contributed to the development of Viagra, which helps produce erections by dilating blood vessels.

Viagra facilitates erections by increasing penile blood flow. Murad’s finding of the role of nitric oxide has also helped numerous premature babies (whose underdeveloped lungs need stimulation).

Dr. Murad died September 4th at his Menlo Park, California (USA) home. He was 86.

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Being able to get an erection is often taken for granted and can be closely linked with how a man perceives himself, being part of their identity. When erection issues then arise, it can result in reduced confidence and self-esteem affecting how a man thinks about himself as a father, husband and in some cases, even at work. Issues with sexual performance can cause relationship problems too as men pull away emotionally from a partner, fearing that they cannot live up to expectations.

Causes of Erection Problems

Most men can experience trouble getting an erection when they are stressed, anxious, tired, or if they have drunk too much alcohol. These situations tend to remedy themselves without treatment and are not necessarily causes for concern.

Other causes can be subtle, while some are more serious and will need further medical investigation. Physical causes of erectile issues can include:

• High blood pressure
• Diabetes
• Heart disease
• High cholesterol
• Neurological conditions such as epilepsy, stroke, multiple sclerosis, or Parkinson’s disease
• Prostate problems, the most common being: enlarged prostate, prostate cancer, prostatitis
• Hormone problems, such as low testosterone

The actual medical treatments for these conditions can in some cases affect erectile function too. A conversation about this with a specialist or your doctor might prove very helpful.

There are, of course, certain emotional and lifestyle factors that can affect sexual performance too, some of which include:

Psychological or emotional factors:

• Depression or feeling low
• Anxieties
• Relationship issues
• Stress at home or at work
• Stress from social, cultural or religious conflicts
• Worry about sexual performance

Lifestyle factors:

• Smoking
• Drinking too much
• Some recreational drugs
• Being overweight

In this article, we will be looking at the medical treatment of erectile dysfunction.

Treatment of Erection Problems

Apart from living a healthy lifestyle and practicing self-care (which will be addressed in another article), there are a number of other treatments available:

Testosterone¹: Some medications can cause a drop in testosterone, the hormone that is thought to regulate a man’s sex drive. Occasionally this drop can have more natural causes; either way, a doctor or specialist can prescribe the hormone in pill format.

Tablets¹,²: You might have heard of Viagra but there are other similar types of drugs available too. These all belong to a group of drugs called PDE5 inhibitors (phosphodiesterase type 5 inhibitors) and include:

• Sildenafil (Viagra)
• Tadalafil (Adcirca, Cialis)
• Vardenafil (Levitra, Staxyn)
• Avanafil (Stendra)

PDE5 inhibitors will enhance the effect of nitric oxide (Mayo Clinic³). Nitric oxide is a chemical the body produces naturally which relaxes the muscles in the penis making it easier for the blood to flow into this area. Please note that PDE5 inhibitors will not help you get psychologically or emotionally sexually aroused, which is a major factor in physical arousal and sexual satisfaction. In other words, you need to want and enjoy sexual stimulation for this medication to work.

Sildenafil, avanafil, and vardenafil can be taken when needed and will be effective for up to six hours. Tadalafil can work for up to 36 hours, providing the opportunity for intimacy to become more spontaneous. Note that these will only produce an erection with physical stimulation or psychological arousal.

Before taking any medication for erection problems, do talk with your doctor. There are some dangers if these are taken with certain other medications or if some medical conditions are present. Specifically, but not exclusively:

• Combined with nitrate drugs — commonly prescribed for chest pain (angina)
• Heart disease or heart failure
• Very low blood pressure (hypotension)

Injections¹,³: Injections in the side of the penis might seem extreme, perhaps off-putting and even painful, but many men find this method helpful and report that it doesn’t hurt. There are two drugs that can be used in this way:

• Alprostadil (Caverject®, Caverject® Dual Chamber, Viridal Duo®)
• Aviptadil with phentolamine mesilate (Invicorp®)

These drugs work similarly to the PDE5 inhibitors, by relaxing the muscles and blood vessels, allowing the blood to flow and an erection to occur. If this method is prescribed, the nurse or doctor will demonstrate how to inject the side of the penis using a very thin needle.

Once the penis is filled with blood, which usually happens within 10 minutes, the erection is likely to last up to an hour.

Pellets or cream¹,³: Alprostadil can be acquired in the form of a small pellet, called MUSE®, or as a cream called Vitaros®. Though they are said to not work as well as the injection, it may be an option if for any reason injections are out of the question.

The pellet or cream is inserted with an applicator into the opening of the penis. Inserting the pellets becomes easier when the opening is already moist, so is it worth urinating before attempting insertion. These usually work within 10 minutes and can last for up to an hour.

The cream, itself moisturising, may be a little easier to insert and some can also be used to massage into the penis to help absorb the drug better. Bear in mind that it does take a little longer for this method to work.

Vacuum pump¹,³: The instrument of a vacuum pump could seem a little medieval, but for some men, this works really quite well.

A vacuum pump consists of a manual or battery-operated pump and a plastic cylinder. This is used to create a vacuum around the penis, enabling the blood to be pulled into the penis, resulting in an erection.

Once you have an erection, the constriction ring which sits at the end of the cylinder is slipped around the base of the penis to stop the blood from flowing back into the body. This ring should not be worn for longer than 30 minutes at a time.

Implants¹: This could be the solution if no other treatment has worked. It involves having an operation to insert implants into the penis. The two possible options are:

• Semi-rigid rods that keep your penis consistently fairly firm but allow it to be bent down when you don’t want an erection.
• An inflatable implant in the penis and a pump in your scrotum (the skin around testicles). When you squeeze the pump the implant fills with fluid (saline) to make the penis hard. Your erection will last for as long as the implant is inflated, and you can deflate it when you want to.

Be warned

If you are experiencing any other health issues, one or more of these issues may be the cause of erectile dysfunction. Some men are reluctant to seek their doctor’s help when something physical isn’t feeling right. The importance, however, of getting the appropriate medical advice cannot be emphasised enough. The earlier that some conditions are detected, the sooner treatment can start and the associated risks minimised.

For example, the symptoms of prostate cancer are⁴:

• Needing to pee more frequently, often during the night
• Needing to rush to the toilet
• Difficulty in starting to pee (hesitancy)
• Straining or taking a long time while peeing
• Weak flow
• Feeling that your bladder has not emptied fully
• Blood in urine or blood in semen

These symptoms need investigating as soon as possible. Prostate cancer kills 12,000 men each year in the UK alone¹; in the US this figure is 34,130⁵. Some of these deaths could be avoided with earlier detection. Don’t become part of this statistic!

If taking medication for erectile dysfunction while also taking medication for another condition, do make sure you seek advice from your doctor first. Some combinations of medication can be dangerous.

Of course, using methods such as those above will only work on a physical level. Emotional and psychological issues can have distressing effects on your sex life too and can influence your ability to have an erection or your enjoyment of physical intimacy. For these issues, it is always best to seek the help of a qualified and licensed (US) or registered (UK) therapist with experience of working with these specific issues.

References

¹ Prostate Cancer UK

² Urology Care Foundation

³ Mayo Clinic

⁴ NHS

⁵ American Cancer Society

The post 6 Ways to Treat Erection Problems appeared first on Medika Life.

The Urology department pilot study sought to analyze penile tissue of men who recovered from symptomatic COVID-19 infection and developed erectile dysfunction (ED) after the infection.

The small study evaluated penile tissue collected from four men scheduled for penile prosthesis surgery due to erectile dysfunction. Two men had a history of Covid-19 infection, and the other two men had no history of illness.

Covid-19 is known to cause widespread damage to blood vessels throughout the body. SARS-CoV-2 causes damage to the cell layer lining blood vessels called endothelial cells. Endothelial cells contain two components that SARS-CoV-2 needs to infect cells. The SARS-CoV-2 spike protein binds to specialized receptors called ACE-2 and enters cells containing an enzyme called TMPRSS-2. Blood vessels have a high number of both ACE-2 receptors and TMPRSS-2.

The Miami research team hypothesized that endothelial damage in penile tissue could be the cause of post-Covid-19 erectile dysfunction.

The researchers evaluated penile tissue collected from four men scheduled for penile prosthesis surgery to test the theory due to erectile dysfunction. Two of the men had a history of Covid-19 infection. One had a severe disease requiring hospitalization. One had a mild case. These two cases were compared to a control group of two men who had no history of infection.

The paper is titled, “COVID-19 Endothelial Dysfunction Can Cause Erectile Dysfunction: Histopathological, Immunohistochemical, and Ultrastructural Study of the Human Penis.“

Urologists took biopsies from an area of the penis called the corpus cavernosum. A variety of tests were performed to evaluate cellular changes in the tissue. Damage to the penile vascular from Covid-19 could explain new onset erectile dysfunction after infection.

The scientists used three techniques to test for the effects of Covid-19. Transmission electron microscopy (TEM), Immunohistochemistry staining (eNOS), and viral PCR testing.

Transmission electron microscopy (TEM) revealed the presence of viral particles in men with a history of Covid-19 infection.

Immunohistochemical staining showed dramatic changes in the penile tissue of men with a history of Covid-19.

The scientists were unable to detect SARS-CoV-2 through PCR testing. The study authors propose the lack of detection is due to a low viral load in the penis.

The sample size of this pilot study is quite small. The results are not meant to provide a definitive scientific answer regarding the effects of Covid-19 on male sexual function. This small pilot study is the first paper to demonstrate penile damage on a cellular level. Further research will be needed.

This paper may also help some men overcome vaccine hesitancy. A study in the American Journal of Men’s Health showed men are less likely to seek help for any medical condition. Data analysis by Kaiser Health showed a gender gap with Covid-19 vaccination. More women are getting vaccinated than men. A CNN poll found 57 percent of Republican men did not plan to get vaccinated against Covid-19.

This paper from The University Of Miami helps men understand the importance of preventing getting infected from Covid-19.

There are three FDA-approved vaccines for Covid-19. The two messenger RNA vaccines from Moderna and Pfizer offer 95% protection against Covid-19. The Covid-19 vaccines from Pfizer and Moderna use messenger RNA (mRNA). A single strand of mRNA delivers instructions to human cells to produce an antibody against the SARS-CoV-2 spike protein.

The Johnson and Johnson’s Janssen vaccine offers 72% protection against infection and 86% against severe disease. The Janssen vaccine uses Adenovirus 26 (AD26) as the vector to deliver DNA material into our cells to provoke an immune response.

The Moderna and Janssen vaccines are approved for those 18 years old and up. The Pfizer vaccine is approved starting at age 16.

All three vaccines are highly effective in preventing death.

This paper shows the Covid-19 vaccine may also protect men from erectile dysfunction.

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