Hepatitis vaccine booster

hepatitis vaccine booster

In 2009, 3,374 cases of acute Hepatitis B in the United States were reported to CDC; the overall incidence of reported acute Hepatitis B was 1.5 per 100,000 population, the lowest ever recorded. However, because many HBV infections are either asymptomatic or never reported, the actual number of new infections is estimated to be approximately tenfold higher. In 2009, an estimated 38,000 persons in the United States were newly infected with HBV. Rates are highest among adults, particularly males aged 25–44 years.
An estimated 800,000–1.4 million persons in the United States have chronic HBV infection. Chronic infection is an even greater problem globally, affecting approximately 350 million persons. An estimated 620,000 persons worldwide die from HBV-related liver disease each year.

Transmission of Hepatitis B

HBV is transmitted through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen, saliva), including

• Sex with an infected partner
• Injection drug use that involves sharing needles, syringes, or drug-preparation equipment
• Birth to an infected mother
• Contact with blood or open sores of an infected person
• Needle sticks or sharp instrument exposures
• Sharing items such as razors or toothbrushes with an infected person

HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing

The Need for a Booster Dose

After several decades of vaccination against hepatitis B virus in newborns, infants, adolescents, and adults, the question remains whether a booster dose is ever needed. Long-term protection is most commonly measured through 4 methods: the anamnestic response after administration of a booster dose, infection rate in vaccinated populations, in vitro B and T cell activity testing, and seroepidemiological studies. Long-term protection is present despite a decrease in anti-hepatitis B surface antibodies over time. The exact mechanism of long-term protection, however, is not yet fully understood. There is no need for boosters in immunologically potent persons as long as a full course was adequately administered that respected the recommended timelines, as evidenced by studies conducted up to 20 years after the original immunization course. However, a booster dose should be planned for immunocompromised patients, based on serological monitoring.

The question that remains to be answered is how long immune memory will last. Early evidence suggests that the answer will come from the power of the initial immune response and from the time since primary vaccination. Long-term follow-up studies during the third decade after vaccination administration are needed to confirm the duration and persistence of immune memory. In addition, studies that follow-up birth cohorts vaccinated >20 years ago are needed as those individuals become sexually active and potentially exposed to HBV infection.

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Candida Yeast Infection Treatment

candida yeast infection treatment

What is candida yeast infection?

Candidiasis is a fungal infection that can affect areas such as the:

• Skin
• Genitals
• Throat
• Mouth
• Blood

It is caused by the overgrowth of a type of yeast called Candida, usually Candida albicans. This yeast is normally found in small amounts in the human body. But certain medicines and health problems can cause more yeast to grow, particularly in warm, moist body areas. This can cause uncomfortable and sometimes dangerous symptoms.

Candida yeast infection symptoms
Symptoms and treatment depend on which part of the body is infected. 

• If it is in the mouth or throat, it is called oral candidiasis, oropharyngeal candidiasis, or thrush.
• If it affects the genital area, it is called a yeast infection. In women, it may be called a vulvovaginal yeast infection.
• If yeast infects the skin on a baby's bottom area, it causes a diaper rash.
• If the infection enters your bloodstream, it is called invasive candidiasis or candidemia.

Candida yeast infection treatment

Candidiasis is commonly treated with antimycotics; such as:

• topical clotrimazole
• topical nystatin
• fluconazole, and 
• topical ketoconazole.

Source:

http://www.webmd.com

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Sexually Transmitted Diseases And Infections

sexually transmitted diseases and infections

Sexually transmitted diseases, or STD, are infections that can be transmitted via sexual contact. Sexual contact does not limit to sexual intercourse only, but refers to kissing, genital and oral sex, and the use of sex toys such as vibrator. STDs consist of many diseases, such as chlamydia, bacterial vaginosis, herpes genital, yeast infection and so on, but the most threatening now is HIV/AIDS.

Here is a list of sexually transmitted diseases and infections.

• Chancroid: a painful sore that causes by bacterial infection; treatable
• Yeast infection: fungal infection on the vagina (female) and the tip of penis (male), causes by fungi especially Candida sp.; treatable.
• Scabies (crabs): bugs that lives in the genital area; treatable.
• Chlamydia: infection on the urethra, pelvis (female), and prostate (male); treatable.
• Herpes: viral infection manifestated as blister and sores; treatable.
• Gonorrhoe: genital infection caused by bacteria: treatable.
• Trichomonas: parasite infection on the pelvis (female) and urethra (male): treatable.
• Syphilis: bacterial infection on nerves, genital, and heart:  treatable.
• Bacterial vaginosis: can cause fluor albus, bad odor, itching and vaginal discharge; treatable.
• Hepatitis: depends on its type (A and E are spontaneously cured; B and C have chance to be a cancer)
• HPV (genital wart): viral infection on the cervix, can be cancerous; cureless.
• HIV/AIDS: no cure.

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Vaginal Infection Causes

vaginal infection causes 

Vaginal infection, or vaginitis, is a medical terminology that means infection and/or inflammation of the vagina. There are many causes of vaginal infection, such as bacteria, yeast, viral, and also local irritations caused by clothing, creams, and so on. 

The most common vaginal infection causes are bacterial, yeast, and trichomoniasis. The origin of them are different but the symptoms are generally similar as described below.

1. Bacterial vaginosis. It is the most common cause of vaginal infection. Gardnerella vaginalis is the name of organism causes bacterial vaginosis. It happens when there is an imbalance in the types of the bacteria normally found in the vulva and vagina. Here are some risk factors that cause them:
• Multiple sexual partner
• Frequent douching habit
• Pregnancy
• Intrauterine device (IUD) use 
• Swimming pools and toilet seats CAN'T spread the bacteria.
2. Vaginal yeast infection. It is mainly caused by fungus named Candida albicans, so it is called candidiasis. The overgrowth of yeast in vagina is possibly caused by any of these events:
• Use of steroid
• Immunocompromized condition (HIV/AIDS)
• Use of antibiotics. Vaginal yeast infection may happen after taking antibiotics therapy for another condition in the body such as strep throat. Antibiotics kill protective bacteria and make the fungus overgrow.
• Pregnancy and diabetes mellitus. In these two conditions, there is a low glycogen store in certain vaginal cells. This causes increasing in vaginal pH that is suitable for fungal growth.
• Menopause.
• Use of birth control pills. Estrogen in birth control pills can change the normal vaginal environment.
• Wearing tight underwear can cause irritation that tends to candidal overgrowth.
3. Trichomonas vaginalis. It is a kind of sexually transmitted disease (STDs) that mostly affects the urinary tract.
4. Viral vaginal infection. It is caused by non specific viruses.

Vaginal infection symptoms

General symptoms of vaginal infection are:

• Itching around the vagina
• Abnormal vaginal discharge with bad odor
• Burning in urinating
• Pain on sexual intercourse.

Vaginal infection treatment

Before taking treatment, we have to confirm the diagnosis. Diagnosis can be based on symptoms and also other diagnostic tests such as: urine tests and vaginal cultures/sensitivity test. The proper treatment is actually based on the cause. If bacterial, take antibiotics as recommended in the sensitivity test. Vaginal yeast infection may be treated by vaginal suppositories and/or antifungal pills.

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Testosterone Booster Effects

 testosterone booster effects 

Testosterone is a sexual hormone that is needed for the growth of male sexual characteristics. The hormone is mainly present in men but actually also found in women, in small amounts. Besides the sexual property, testosterone is also necessary in bone and muscle production. In certain conditions, such as decline in muscle mass and bone density, low libido, mood swings, and gain weight, those are symptoms of low testosterone levels. Sometimes it can also lead to premature ejaculation and impotence in men. Aging can also cause "andropause" in men, and the main problem of it is hypotestosteronism. 

Many people, such as athletes, body builder, etc, want to gain muscle by taking testosterone booster. Testosterone booster effects are mainly caused by raising of testosterone levels in the body. Besides that, testosterone booster can also stimulate fast muscle growth and recovery, burns fat, increase sexual performance, enhance endurance, energy, and stamina. 

By indication, doctors prescribe testosterone booster to the concerned persons. In the market, there are some testosterone boosters. They are available in two types, the legal and the illegal one. Testosterone boosters that include creatine are generally safe, but testosterone booster that is combined with anabolic steroids can have many side effects, especially in long term use.

Taking testosterone booster is not always safe. Taking testosterone booster for a long period can make the body unable to produce the hormone naturally. Besides that, here are another testosterone booster side effects:

• Acne because of oily skin
• Baldness in men because of fast hair loss
• Because testosterone is metabolized in the liver, long term use of it can cause liver damage and in some cases it can cause liver cancer
• For diabetics, testosterone is harmful because it can cause impaired glucose tolerance.
• Kidney failure is also reported after long term use of testosterone booster.
• Prostate enlargement and prostate hypertrophy
• In women, testosterone may lead to the development of male sex characteristics, such as facial hair and deep voice like men.

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Testosterone Injections Side Effects

testosterone injections side effects

We have already known that testosterone is a male sex hormone that is produced in the testicles. It is the principal hormone responsible to promote development and growth of male sexual organs and maintain secondary sexual characteristics. In women, testosterone is also produced in small amounts in ovaries and adrenal system.  Nowadays, testosterone therapy is indicated for both sexes to treat conditions caused by a lack of this sex hormone, such as: impotence, puberty disorder, metastatic breast cancer (cancer that spreads to other parts of the body).

As listed in MIMS-UBM Medica, the indications of testosterone and derivative therapy are:

• Delayed puberty, male hypogonadism
• Inoperable metastatic breast cancer

Before getting testosterone injections therapy please make sure that you don't have contraindications for this such as:

• Male breast cancer
• Prostate cancer
• Pregnancy
• Allergic history to hormonal treatment

After getting the therapy, you have to be aware of the testosterone injections side effects. What are they?

• Most common: headache, nausea, confusion, appetite loss, weakness, increased thirst
• Increased frequency and erection of the penis
• Rapid weight gain
• Fluid and electrolyte retention
• Spermatogenesis disorder, priapism, gynaecomastia, prostate hyperplasia, prostate tumor (rare)
• Suppression of lactation, increased libido, oily skin, acne, hirsutism, clitoral enlargement
• Local irritation of the injection site
• Increased cholesterol, especially LDL.
• Fatal side effects: hepatitis, liver toxicity, malignant neoplasm.

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Chlamydia Trachomatis Infection

chlamydia trachomatis infection 

Chlamydia trachomatis infection is one kind of sexually transmitted disease (STD) that caused by a bacteria named Chlamydia trachomatis. Chlamydia trachomatis infection can cause a damage on reproductive organs, although the infection are usually asymptomatic. Serious infection can cause complications such as infertility. And it can happen in both men and women.

Epidemiologically, chlamydia trachomatis infection is the most frequently  bacterial STD in the United States. The prevalence number tends to be under reported, because most people with chlamydial infection are not aware of the infection and do not seek testing. Women is reported more common than men because they are frequently reinfected if their sex partners are not properly treated.

Chlamydia trachomatis infection can be transmitted in many ways:

• Sexual activities: oral, vaginal, or anal sex. People who are sexually active are at risk of chlamydial infection. Multiple sexual partners also increase the risk. Young women and teenage girls are susceptible to chlamydial infection because the opening of uterus (called cervix), is still immature. Homosexual people are also at risk for chlamydial infection.
• Vaginal childbirth (from mother to newborn)

According to American Family Physician, most of chlamydia trachomatis infections affect the urogenital tract. The symptoms of  chlamydial infection are:

• Women: 
• Abnormal vaginal discharge with burning sensation while urinating. 
• Low back pain
• Nausea
• Fever
• Lower abdominal pain: if the infection spreads from cervix to fallopian tubes.
• Pain during intercourse
• Bleeding between periods.
• Rectal pain, discharge, bleeding: after anal sex.
• Men:
• Burning sensation when urinating
• Itching around the opening of the penis
• Discharge from penis
• Rare cases: pain and swelling in the testicles
• Rectal pain, discharge, bleeding: after anal sex.

Chlamydia infection treatment

• The main treatment is antibiotics. 
• Azithromycin single dose, or
• Doxycycline twice daily, a week
• Sexual partners must be tested and treated. If no, there will be a high risk for re-infection
• No sexual intercourse during treatment to prevent transmitting from infected people to their partners.
• Evaluation test should be done at least 3 months after treatment.

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How To Lower Androgenic Hormones

how to lower androgenic hormones

Androgenic hormones are steroid hormones that control the development and maintenance of masculine characteristics. The main source of androgenic hormones in the body is the testes. Androgenic hormones are also the original anabolic steroids and also precursors for female sex hormones called estrogens. Testosterone is the most famous androgen that has profound effects throughout the body. Testosterone also plays a role in governing behaviors such as risk taking, aggression, territoriality, and mitigating depression.

Androgenic hormones can be stimulated by such things below.

• Physical exercises, such as sprinting and resistance training, but avoid overtraining.
• Have a good night sleep everyday. It will reduce cortisol levels and directly promote testosterone levels. 
• Take a relaxation during your busy time. Take time to go out with friends, read some books, etc.
• Eat dairy and animal products. Be sure you choose the clean and natural ones.
• Eat more essential fatty acids, such as peanuts, avocado, fish, and healthy oils like flax seed, canola, and olive. As we've known, cholesterol is the basic material to make testosterone. High fiber diet tends to lower androgenic hormones, so sometimes we have to make it balanced.
• Take vitamin D supplement and more activity under the morning sun.
• Take zinc supplement. Zinc deficiency will lower androgenic hormones.
• Reduce alcohol consumption.
• In females, reduce soy intake because it increases estrogen levels and lowers androgenic levels.
• Increase sexual activity can also stimulates androgenic hormones.  

How to lower androgenic hormones?

High level of androgenic hormones is bad for women, because it is associated with hirsutism, or unwanted hair growth. Here are some natural ways you can try.

• Dietary soy-phytoestrogens. Recent study concludes the beneficial effects of dietary phytoestrogens on regulatory behaviors (food/water intake, body weight, and locomotor activity), prostate enzyme activity, prostate weight, and reproductive hormon levels.
• Consume these natural remedies: herbal tea (like spearmint tea), black cohosh capsules, saw palmetto and chaste tree capsules.
• Consume natural supplement made from broccoli and cauliflower called DIM (Diindolylmethane). The dose is 120 mg daily
• Consult an acupuncturist to have a serial therapy to lower androgenic hormones.

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Side Effects Of Viagra And Cialis

side effects of viagra and cialis

What is Viagra and Cialis?

Viagra and Cialis are drugs of choice for erectile dysfunction and pulmonary arterial hypertension treatment. It was first available on the market at 1998.

The content of Viagra is sildenafil citrate, manufactured by Pfizer. According to MIMS.com, the recommended dose for most patients is 50 mg taken as needed, 1 hour before sexual intercourse. However, Viagra may be taken anytime from 4 hours until 0.5 hour before sexual activity. Based on its effectiveness, eficacy, and tolerance, dose of Viagra may be increased to a maximum dose of 100 mg, once per day, or decreased until 25 mg, once per day.  In patients with renal and liver impairment, the plasma level becomes higher, so the starting dose must be reduced to 25 mg. Based on the pharmacokinetic data, it is recommended not to exceed a minimum single dose of 25 mg in 48 hours period. It can be taken with or without food.

Here are some contraindications of Viagra:

• Newborn, children, women
• Patients with a known allergy to Viagra's component
• The use of nitrates after taking Viagra must be careful, but it is better not to administer both of them together.

Side effects of Viagra:

• Flushing
• Headache
• Dizziness
• Abdominal discomfort (dyspepsia)
• Diarrhea
• Urinary tract infection
• Nasal congestion
• Abnormal vision
• Rash

Special precautions must be considered at this conditions:

• Men with cardiovascular inadequacy and because of that, sexual activity is not recommended (post myocardial infarction, stroke, arrhytmia)
• Congestive heart disease
• Coronary heart disease and angina
• Resting hypotension (under 90/50) and severe hypertension (more than 170/100)

Cialis was first available on the market at 2003 in United States, discovered by GlaxoSmithKline and in 2007 was owned by Eli Lilly. The difference of Viagra and Cialis is that Cialis has a longer duration of action. The dose of Cialis is 10 mg taken with or without food, 30 minutes before sexual activity. Contraindications of Cialis are:

• Women or people under 18 years old
• Patients with any cardiovascular disease

Side effects of Cialis are nearly similar to side effects of Viagra, such as:

• Abdominal discomfort
• Headache, dizziness
• Flushing
• Nasal congestion, runny nose
• Back pain and muscle pain
• Swelling of palpebra (eyelid), eye pain, and conjunctival hyperaemia (very rare)

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Erectile Dysfunction In Young Men

erectile dysfunction in young men

Erectile dysfunction, or sometimes many people referred it as impotence, is a men's condition that is unable to achieve an erection, or maintain an erection for a long period of time to finish the sexual intercourse. 

Most people think that impotence or erectile dysfunction is a condition that occurs older men. In fact, erectile dysfunction can affect young men and any man that has already reached sexual maturity. There is no specific number about how many young men that are affected by erectile dysfunction. It is due to the fact that young people who get erectile dysfunction problems are less likely to talk to others about their problem. 

Many risk factors play an important role on erectile dysfunction in young men. The most likely is anxiety (it is natural), and fear of becoming pregnancy, fear of being caught, having bad sex experiences, and fear of STDs (sexually transmitted disease). Besides that, bad lifestyle also contributes in erectile dysfunction such as alcohol consumption, heavy smoking, and obesity. But when erectile dysfunction continues happening, it is very important to seek for professional and have medical check up if there is any underlying disease that may become the cause of erectile dysfunction in young men.

Treatment of Erectile Dysfunction in Young Men

There are some suggested steps:

• Meet the professionals to have a complete medical examination. 
• Take the drugs prescribed by doctors (please understand the side effects!)
• Take natural/herbal aphrodisiacs to arouse sexual desire.
• Meet the psychologist if you have any psychological problems.

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Vaginal Yeast Infection Treatment

vaginal yeast infection treatment

Vaginal yeast infection is the most common problem in women. The symptoms are itching, burning, irritation, redness, and white or yellowish vaginal discharge with strong odor. Predominantly, vaginal yeast infection occurs in childbearing age women. There are some conditions that provide a chance for vaginal yeast infection, such as broad spectrum antibiotics, poor nutritional status, over consumption of sugar, contraceptive pills, hormonal shifta and immunocompromised problems.

Vaginal Yeast Infection Treatment

There are some treatment choices that can be used in first aid vaginal yeast infection treatment :

• Boric acid. This remedy has antiseptic and antifungal properties. It is used as vaginal suppositoria. The side effects are vaginal burning and skin allergy/irritation.
• Essential tea tree oil. This is a natural remedy, used by diluting and applying topically to the vulvovaginal area.
• Antifungal drugs
• Antifungal tablet. Mostly used is fluconazole (Canesten, Diflucan). Antifungal tablet can be very effective, usually one tablet as single dose is enough to cure vaginal yeast infection. Side effects include nausea, vomiting, diarrhea, bloating, and constipation. Pregnancy and breastfeeding are contraindications for this treatment.
• Pessaries. Intravaginal pessaries do not have systemic effects, can cause local irritation. Examples for intravaginal pessaries are clotrimazole (Canesten), econazole (Ecostatin), and miconazole (Gyno-Dactarin). Pregnancy is also contraindication because it will cause cervical injury.
• Creams. Creams are additional therapy to tablet and pessaries to cure redness and soreness around vagina, vulva, or perineum.

Vaginal Yeast Infection Treatment Failure

The failure of vaginal yeast infection treatment can occur due to: patient's poor compliance, longer use of oral and topical drugs, double infection with bacteria, or there are underlying diseases that worsen the infection.

Vaginal Yeast Infection Treatment at Pregnancy

Drugs of choice are: tropical clotrimazole, miconazole, and econazole. Avoid to use nystatin because it is less effective.

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Vaginal Yeast Infection Symptoms

vaginal yeast infection symptoms

Vaginal Yeast Infection is usually caused by a yeast or fungus called Candida albicans. This yeast is normally found vulva and vaginal area as flora normal. Statistically, it is estimated that three of four women (75%) will have vaginal yeast infection at least once in their lifetime.

There are risk factors that contribute to vaginal yeast infection such as: diabetes mellitus, pregnancy, oral contraceptive using, prolonged broad spectrum antibiotics using, and chronic use of corticosteroid. Vaginal yeast infection is commonly found in after menopausal women, because of decreasing estrogen levels within the vaginal wall.

Vaginal Yeast Infection Symptoms

• White vaginal discharge (it is the most common symptom). The texture is similar with cottage cheese.
• Dyspareunia (pain on sexual intercourse)
• Pain on urinating
• Red and swollen area around vagina and vulva

Vagina yeast infection is basically not a emergency condition. But in people who have low immunity status (HIV, prolonged corticosteroid user, pregnancy), it will be possible fot the infection to spread into the blood stream and cause systemic yeast infection, a potentially life-threatening problem. The vaginal yeast infection symptoms that may be life-threatening are:

• High fever (more than 38 celcius degree)
• Severe pelvic pain or abdominal pain
• Bleeding while pregnant
• Chest pain
• Respiratory problems: shortness of breath (dyspnea), wheezing, etc
• Nausea and vomitus

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Impotence Erectile Dysfunction

Impotence Erectile Dysfunction

Impotence and Erectile Dysfunction

There are many disorders that happens in male sexuality. Impotence and erectile dysfunction become a great concern. Erectile dysfunction is a condition when a man is unable to ensure sufficient stiffness of the penis for satisfactory sexual intercourse; or erection do not reach long enough to be maintaned. This condition used to be called as impotence.

But actually, there are two different understandings that are sometimes used as synonyms, they are: impotence and sterility. Impotence is a very general term , but refers to inability to have sexual intercourse. In the other hand, sterility means the inability of a man to reproduce, also known as impotence, with erectile function is not restricted in the rule. 

Erectile dysfunction can be temporarily/occasionally, until permanently loss of erectile function. In medical terms, erectile dysfunction means when a man can achieve within  months from about 70% of the experiments a sufficient erection.

There is a wrong myth that impotence erectile dysfunction is a part of aging. It is true, actually, as a man get older, he may need more stimulation to get an erection; he also need more time between erections. But older man basically must still be able to get an erection and have a good sex.

Impotence & Erectile Dysfunction Causes

Here are many causes of impotence erectile dysfunction:

• Hypertension, and its prescription drugs
• Diabetes mellitus
• Depression, phychological stress, anxiety, and its prescription drugs
• Chronic alcoholism
• Heavy smoking
• Neurologic disorder: multiple sclerosis, brain tumor, spinal cord injury, Parkinson's disease, stroke
• Complications after prostate and bladder surgery

Impotence & Erectile Dysfunction Treatment

Basically, the treatment for erectile dysfunction depends on what causes it and underlying diseases/ factors. Drug of choice for erectile dysfunction is Sildenafil (brand name: Viagra), tadalfil, and vardenafil. They are taken orally to help maintain an erection. These drugs also have some contraindications, so not everyone can use it. Your doctor may also give you alprostadil if oral medicines above aren't suitable for you. Alprostadil is a prostaglandin E's synthetic drugs.  It is given via injection into the penis or inserted into the urethra. Other choices are vacuum pump devices, a penile implant, or surgery. For surgery, you better contact an urologist. Which treatment is the best for you? Please consult your doctor.

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Causes Of Priapism

Causes of Priapism

What is Priapism?

Priapism is one type of male sexual disorder where penile erection occurs continuosly for 6 hours or more even without sexual stimulation. It is very painful; can damage the penile tissue permanently.

In general practice, the usual recommendation to seek medical emergency for help is painful erection that persists for more than FOUR hours.

Causes of Priapism

Normally, erection results from relaxation of the muscles inside the penis. It makes an increase in arterial blood flow towards the penis. Priapism occurs when blood inside the penis is trapped and unable to flow seamlessly. This condition can occur at all age groups, and even newborn! If it is not properly treated, permanent damage may happen.

Causes of priapism are:

• Drugs/medical treatment: psychiatric drugs (CPZ, trazodone), antihypertensive drugs (nifedipine, prazosin), anticoagulants (heparin, warfarin), miscellaneous (metoclopramide, omeprazole, tamoxifen)
• Alcoholism
• Trauma (accidental, surgical)
• Nervous system damage, such as: spinal cord injury, chronic diabetes mellitus, multiple sclerosis.
• Blood disorder, such as leukemia, sickle cell anemia, myeloma, thalassemia.
• Injection into the penis to treat impotence, such as papaverine, prostaglandin E1 (alprostadil), Viagra (R), phentolamine, etc.
• Unknown causes, approximately 35% of the priapism cases.

Treatment of Priapism

Many priapism cases resolve spontaneously after physical activity and repeated ejaculation. In emergency practice, oral terbutaline or salbutamol may help in acute onset. Next step is removing blood by inserting a needle into the penis (often followed by small amounts of heparin to reduce clotting). In persistant cases, metaraminol (a reversing agent) may be injected into the penis. Surgery is rarely performed, but its purpose is to avoid persistant damage of the penis muscle.

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