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If you have taught your child all the rules of ‘stranger danger’ you have protected him/her from a 1% chance of being sexually abused. This leaves your child vulnerable to the most likely sexual child abuse offender, family members or other trusted adults. 80% of children are sexually abused by a family member, 19% are abused by someone the child knows and trusts. The other little known statistic is the frequency of sexual child abuse. David Finkelhor and Dianna Russell’s research reveals 62% of girls and 31% of boys will be sexually abused by age 18. Unfortunately this statistic is considered low due to the difficulty in gathering data through surveys or reporting agencies. For many decades we have screamed, ranted, condemned, demanded and enacted legislation to punish sex offenders to little avail. The news media and magazines have joined in the campaign to illuminate the problem after the damage is done. As a result of the media’s incessant coverage and hype of ‘strangers,’ we have come to believe if we teach our children about ‘stranger danger,’ we have thoroughly protected our children from this horrific crime. The first response we form when hearing of sexual abuse or incest is denial. ‘I don’t have to be concerned about that in my community. That would never happen in my family.’ The unbelievable reality is that a person who sexually abuses children may seem very average and ordinary to the world. Furthermore, we find sexual abuse and incest even more difficult to believe or accept when the person we like, admire, love, and/or marry is the perpetrator of the abuse. Tragically, the unwillingness to accept the facts concerning sexual abuse perpetrators leaves children vulnerable to becoming victims and increases the likelihood that they will be abused. To understand how sexual child abuse is perpetrated by the person we least suspect one needs to have a comprehensive definition of sexual abuse. “Traditionally, incest [sexual abuse] was defined as: sexual intercourse between two persons too closely related to marry legally--sex between siblings, first cousins, the seduction by fathers of their daughters. This dysfunctional blood relationship, however, does not completely describe what children are experiencing. To fully understand all sexual abuse, we need to look beyond the blood bond and include the emotional bond between the victim and his or her perpetrator. Thus, a new definition has emerged. The new definition now relies less on the blood bond between the victim and the perpetrator and more on the experience of the child. Incest is both sexual abuse and an abuse of power. It is violence that does not require force. Another is using the victim, treating them in a way that they do not want or in a way that is not appropriate by a person with whom a different relationship is required. It is abuse because it does not take into consideration the needs or wishes of the child; rather, it meets the needs of the other person at the child’s expense. If the experience has sexual meaning for another person, in lieu of a nurturing purpose for the benefit of the child, it is abuse. If it is unwanted or inappropriate for her age or the relationship, it is abuse. Incest [sexual abuse] can occur through words, sounds, or even exposure of the child to sights or acts that are sexual but do not involve her. If she is forced to see what she does not want to see, for instance, by an exhibitionist, it is abuse. If a child is forced into an experience that is sexual in content or overtone that is abuse. As long as the child is induced into sexual activity with someone who is in a position of greater power, whether that power is derived through the perpetrator’s age, size, status, or relationship, the act is abusive. A child who cannot refuse, or who believes she or he cannot refuse, is a child who has been violated.. (E. Sue Blume, Secret Survivors).” There are two types of sexual abuse approaches—overt and covert. Overt sexual abuse is openly sexual and apparent. Although there may be an attempt to deny that it is abusive, there is no attempt to hide the fact that it is sexual in nature. Covert sexual abuse is more insidious. Thus, identifying it is harder, because the sexual nature of the action is disguised. The perpetrator acts as if she/he is doing something non-sexual, when in fact he or she is being sexual. The betrayal then becomes two-fold. The child is not only abused, but also tricked or deceived about the act. In this dishonesty, the child is unable to identify or clarify his/her perception of the experience. The unreal or surreal sense that accompanies any sexual abuse is intensified when the child is tricked into disbelief. Thus, the child doubts his/her perceptions and feelings and believes that there is something wrong with him/herself because he/she feels terrible. To make matters worse, everyone around her/him discounts signs of the abuse, because we don’t want to believe someone with a sterling public image would do such a thing. Thus the child feels crazy, as if she/he is the one with the problem. One example of overt sexual abuse whereby the perpetrator disguises his actions and those present are in denial about what is transpiring is exemplified by the incident a client, who is a sexual abuse survivor, reported seeing. Her father (her perpetrator) kissed his granddaughter, her one-year-old niece on the pubic area after her niece finished her bath. Her sister, the child’s mother, the child’s grandmother (wife of the perpetrator) were present. “My sister and mother (the child’s grandmother) laughed and I got sick to the stomach. Am I over reacting,” she asked. Obviously, her sister and mother are unaware of the definition of sexual abuse. Except for the fact this woman was in therapy she would not have considered it sexual abuse either. An example of covert sexual abuse by someone we least expect is exemplified by a 39 year-old woman who came to me after having a severe panic attack. During our investigation as to the root cause of the panic attack she revealed she had been ‘fondled’ when she was nine by a family friend. “He helped me on with my coat at a family gathering. As he adjusted my coat onto my shoulder, he fondled my breast.” This type fondling is often times referred to as ‘coping a feel.’ No matter the label, it is sexual abuse and causes damage. Women know how icky it feels when a man ‘cops a feel.’ Can you imagine what it would feel like for a nine-year-old, who has no information to comprehend and emotionally resolve what she experienced? Another example of covert sexual abuse by someone you least expect was told to me by my client, Rickie (not his real name). He remembered being held by his mother’s best friend in the water at the beach when he was six, while his parents sat on the beach. Fully protected from view by the water, she fondled his penis. This was not the end of the sexual abuse. When Rickie was 15 years old, she enticed him to have sex with her at her home while he waited for her son, his friend to come home. The second incident of her sexual abuse of Rickie was overt. There are six key techniques to abuse-proof your child. •Avoid spanking your child—spanking is a body boundary violation. Perpetrators target children who have had body boundary violations because they are less apt to protest any unacceptable body boundary violations, are more compliant with adults and are less apt to tell. You can avoid your child from falling prey to these cunning perpetrators by doing everything to avoid making your child a target. •Avoid touching your child in erotic areas—buttocks, chest, thighs, etc. Perpetrators state they use familiar touch (rubbing the child’s legs, buttocks or hugging/kissing) to desensitize the child before using touch which is sexual in content and intent. If your child is unaccustomed to being touched in erotic areas, he/she will protest immediately. Protesting will either thwart the perpetrator or alert anyone nearby that something is awry. •Teach your child self-protection by teaching him/her to protest violation of body boundaries or unwanted touch beginning at age two. •Practice and teach your child good body image. •Practice and teach your child to TELL YOU EVERYTHING, NO SECRETS FROM MOMMY and DADDY. •Practice and Teach Appropriate Suspicion—Trust your intuition, (a.k.a Sixth Sense) discount vig rx penis enlarement surgery cost penis enlarement information penile enlargement surgery top rated penis enlargement pill do pennis enlargement pills really work penis elargement pump free penis enlargment

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Cunnilingus if performed correctly has the potential to give women exceptional orgasms and many women actually prefer Cunnilingus to full intercourse in terms of satisfaction. To learn the art of cunnilingus takes a little practice and below we have outlined some tips to improve your technique below. The art of cunnilingus takes some practice but its practice both you and your partner will enjoy! Oral Techniques The Initial Lick As a start, try licking her from vaginal entrance up her clit and following the outer edges of her vagina covering both sides, going up and down and vice versa can be a great way to start your love making and will relax her and get her in the mood. Holding The Labial Hold the two parts together gently with your lips, run your tongue between the inner and outer labia one side at a time and repeat. Tongue Intercourse The majority of a woman’s nerve endings in her vagina are around the opening and within the first couple of inches inside. Hit them with your tongue when perorming Cunnilingus by inserting it into the vaginal opening, then licking gently in circular motions combined with flicks of the tongue. Flicking Spread her outer vaginal lips with your fingers. With your tongue pointed, gently lick and flick your tongue across the clitoris and into the vagina. When doing this make sure go gently and see the response before being harder with your tongue. Most women need to be extremely wet to enjoy this as it is quite an intense feeling for many women. Sucking Expose her clitoris by spreading her lips and gently pull back her hood. Suck the clitoris (be gentle) and then let it go and repeat again. This can be an incredible turn on and will be very frustrating, warming her up for the other Cunnilingus techniques that are outlined here. Holding The Clitoris Take the clitoris in your mouth and suck on it gently, at the same time flick your tongue around it. This can be done very lightly or aggressively or a combination of the two (find out what your women likes first) this is normally intensely arousing when done correctly. Its as simple as A-B-C Try using your tongue to spell the alphabet when performing cunnilingus. This is very arousing as your tongue is moving in lots of different directions. You can use any letters you wish, not just ABC! Listen to the ones that give her most pleasure and remember them! Other points to keep in mind to make cunnilingus pleasureable are 1. Share a shower or bath together before you start to make sure that you are both clean and add gels and lubricants to enhance taste and stimulation if you wish. 2. Ask your partner what she likes. She can give you directions such as harder, slower, faster, more circles etc 3. Fill your own mouth with as much saliva as you can before you begin and never touch or lick the clitoris when performing Cunnilingus with a dry finger or tongue. 4. Don't go for the clitoris make sure she is warmed up and aroused. Try gentle kissing and licking around the upper thighs and vulva area and work your way up to the clitoris. 5. Use a variety of ways to arouse her. If you repeat the same motion, your partner can become insensitive to it, keep in mind variety with Cunnilingus and keep her expectations up. 6. As she becomes more aroused, insert a finger or two into her vagina as well. 7. Continue to touch and hold her as she orgasms and after and make her feel wanted and loved. 8. The clitoris has more nerve endings than the entire head of the penis, so be very careful not to be to hard with it go gently and remember ask her all the time what she likes and doesn’t. Cunnilingus can enhance any relationship and most women love it and getting it right is all about communication. Following the above tips on cunnilingus will help you satisfy your partner and will enhance your relationship. easy enlargement free pnis surgery way vimax penis enlargement technique free penis enargement exercise manual penis elargement exercise natural pnis enlargement best pnis enlargement surgery penis enlagement pills product manual penile enlargment exercise cheap penis elargement pills

Liposuction Breast Reduction – some useful information Liposuction breast reduction can be performed in both females and males. Liposuction is performed on males in areas like the breasts, abdomen, flanks, and the face. Enlarged male breasts have been successfully treated by liposuction breast reduction technique. Pseudo-gynecomastia and gynecomastia During puberty in males, as a temporary condition, excess breast tissue develops which usually subsides in 1 to 3 years. However, in some cases, the enlargement of the male breast does not subside and remains permanent. This results in the male breast resembling a female breast. The normal male breast contains both glandular and fat tissue. The glandular tissue, surrounded by fatty tissue, is generally situated under the nipple as a localized lump. A mammogram can determine how much glandular tissue and how much fatty tissue is in the male breast. A male with excessive fat tissue has an enlarged breast known as pseudo-gynecomastia, and it occurs in many men as they become older and in obese younger men. Liposuction breast reduction can be effectively done on pseudo-gynecomastia as it contains more fat tissue than glandular tissue. Gynecomastia is an enlarged male breast, which contains more glandular tissue than fat tissue. The fat tissue can be removed by liposuction; however, removal of the glandular tissue requires surgical excision by mammaplasty. An enlarged male breast may also be the result of a breast tumor, which only a mammogram can prove. Gynecomastia can happen due one or many reasons like metabolic and hormonal disorders, non adequate testosterone, hyperthyroidism, too much starvation, medication after effects, too much drinking of beers and other alcoholic drinks, testicular cancer, breast tumors and steroid and marijuana use There are few drugs having side effects of gynecomastia Amiloride (Moduretic), Amiodarone (Cordarone), Antiandrogens (cyproterone), Anticancer drugs (cytotoxic) Gynecomastia can be removed by surgery, medication wrc.. How liposuction breast reduction surgery can help? Liposuction breast reduction can help to produce a smaller version of the breasts. Usually the size changes, but the shape of the breast remains the same. The male gets a manlier shaped breast and his self-esteem increases, as the attending anxiety and embarrassment in participating in some activities is eliminated. After the fat tissues are removed with liposuction, specific breast exercises can be done to tighten the glandular tissues and give a look of manliness to the overall chest area. There may be a lumpiness and swelling experienced for few weeks postoperatively, which subsides in 2 to 4 months. Is hospitalization required for treating gynecomastia? Usually, it is done on an outpatient basis, and no hospitalization is required as general anesthesia is used. The majority of patients can return to their normal activities within few days. Do insurance pay for gynecomastia? Usually, the reimbursement for gynecomastia is not done by major insurance companies. Possible risks and complication in Liposuction for breast reduction The risks of liposuction breast reduction are similar to any surgical operation. However, the risks are minor and can be treated with liposuction breast reduction techniques. permanent penis elargement top penis enlarement pills pnis enlargement herb pennis enlargement information magnarx cheap penis enargement best penile enlargement surgery vimax free penis enlargement technique cheap penis elargement pills

Believe it or not, there is a natural ingredient from Europe that can help change the way your legs feel and the way you feel about the circulation in your legs. Whether we realize it or not, the circulation in our legs can have a huge influence on how we feel and what we do everyday and perhaps even more so every evening. The comfort level of our legs, or better said, their discomfort level at the end of the day can adversely affect our social life and fitness activities - not to mention adversely affecting our sleep. If our legs felt better perhaps we would find it easier to do the things we'd love to do, but find it so difficult to muster the motivation. As if the way our legs can feel at the end of day isn't challenging enough, the changes in the circulation in our legs as we age can seem even more hopeless and discouraging. Now add to that the seeming conspiracy among fashion designers to have us exposing even larger portions of our aging legs and we have a problem that over 80 million Americans with varicose veins understand all too well. (1). Unfortunately, about half of all American women will develop varicose or spider veins at some point in their lives (2). Not only are they unsightly, these leg problems can also cause significant discomfort. Typically, varicose veins are characterized by bulging, blue, sometimes painful and inflamed veins that appear primarily in the calves and thighs. Spider veins, on the other hand, show up as a web of fine lines that can make your legs look like a road map. While age and heredity play a role in the development of varicose and spider veins, weight gain, pregnancy, menopause and the use of hormone replacement therapy can also trigger these vein problems. Making matters worse, chronic inactivity, standing for long periods of time or habitually crossing your legs can make you more prone to injured veins (2). Conventional treatments include surgical stripping, injecting the veins with a chemical irritant or zapping them with lasers. While these approaches can remove existing varicose or spider veins, they will not prevent new ones from developing, since these high-tech treatments do not address the underlying problem of poor circulation. Worse yet, these procedures can also cause infection, scarring, nerve damage and pain (26). If these radical treatments are not an option for you, you'll be happy to hear that there is a natural approach that not only improves the appearance of these ropy, bulging veins, it also fosters leg health to prevent future problems. Veins Explained To understand how varicose veins develop, you need to know a little bit about how blood moves through the body. Essentially, there are two types of major circulatory vessels in the body: the arteries, which channel blood from the heart to the extremities, and the veins, which bring blood from the extremities back to the heart. Of all the veins in your body, leg veins work the hardest to carry blood back to the heart. To accomplish this difficult task, your legs are equipped with specially designed one-way valves that keep the blood moving in the right direction. As efficiently as these valves work, your legs still fight a constant battle against the natural pull of gravity. If the veins can't move the blood efficiently or the one-way valves that prevent the blood from backwashing fail to close properly, blood collects in the legs. This pooling of blood then stretches the vein, causing swelling and injury to the vein's walls (3). Depending on the extent of the enlargement, these veins can show up as either spider or varicose veins. Spider veins are broken capillaries and small veins that appear as jagged red, blue or purple lines on the surface of the skin. While they aren't painful, they can be extremely unattractive. Varicose veins, on the other hand, are thick veins that run deeper beneath the skin. They are far larger and much less attractive than spider veins - and they can make your legs feel fatigued, heavy, achy or even itchy. Varicose veins can also cause burning, throbbing, cramping and restlessness. While these conditions aren't usually dangerous, severe cases can lead to chronic venous insufficiency - a persistent inability of the leg veins to adequately return blood back to the heart (4). Varicose veins are also associated with the development of skin ulcers or a chronic inflammation of a vein - a condition known as phlebitis. Phlebitis is often accompanied by formation of a blood clot, a dangerous situation since the clot can move from the leg vein and travel to the lungs (2). Get a Leg Up with Diosmin Your strategy for battling vein problems naturally is twofold: improving circulation and strengthening the vein walls. The first and simplest measure to improve blood flow is to counteract gravity. Standing or sitting all day makes it harder for blood to move up from the legs and back to the heart. But taking a few minutes to rest with your legs higher than your heart each day allows gravity to help return blood to the heart. Getting in shape can also help relieve varicose and spider veins - and it can even prevent new ones from forming. As we age we lose muscle tone, which adversely affects the health of our legs. Yet adopting a consistent exercise program promotes good circulation and can help to keep our leg muscles, and the blood vessels in our legs, toned. Walking, weight training, low-impact aerobics and swimming strengthen the legs and circulatory system, and help to reduce the throbbing and aching often associated with varicose veins. What you eat can also ease unsightly veins. A low-fat diet filled with fruits, vegetables, beans, legumes and whole grains add key nutrients and fiber to your diet. Eating a fiber-rich diet reduces the chances of constipation which can contribute to varicose veins. Constipation restricts the blood as it returns to the torso through the deep veins in the legs. Straining to have a bowel movement closes off the deep veins in the legs and restricts the flow of blood as it returns to the torso. As the blood backs up, it takes another course through superficial veins, thus the blue streaks in the legs. Eating a fiber-rich diet alleviates and prevents constipation, helping to avoid the damage to the vascular system that can result. In addition to fiber, a diet high in fruits and vegetables also ensures adequate intake of nutrients and phytonutrients, which also help tonify the blood vessels. As a bonus, a healthy diet and exercise program can also jump-start weight loss - an important consideration since carrying too much weight creates extra pressure on your heart and blood vessels, interfering with healthy circulation (2). To strengthen the veins themselves, take a tip from the Europeans. From Austria to France to Italy, women and their doctors have relied on Diosmin for more than 30 years to treat circulatory problems affecting the legs - and with good reason. Diosmin is a unique bioflavonoid derived from citrus fruits and is closely related to other citrus bioflavonoids such as hesperiden, quercetin, and rutin (5). Clinical trials have shown that Diosmin is highly effective in boosting circulation and strengthening the veins in the legs (5). Not only does this improve existing varicose and spider veins, it can also reduce the likelihood of future problems. What makes Diosmin so amazing is its power to specifically target the blood vessels in the legs. Diosmin improves both blood vessel elasticity and microcirculation while relieving pain and inflammation by inhibiting pro-inflammatory prostaglandins and thromboxanes (21,24). Because of its direct action on the integrity of vein walls, Diosmin also reduces the amount of fluid that leaks out of them (21,22). Diosmin's protective benefits do not stop there. Because it is a potent anti-oxidant, Diosmin decreases lipid peroxidation and reduces free radical damage that can undermine vein health (23, 27). In one clinical trial, people who suffered from pain and swelling due to varicose veins experienced significant improvement in their symptoms after taking Diosmin for a few months (6). A review of studies also found that, among more than 5,000 patients with vein disorders, the vast majority not only saw a reduction in their discomfort, they actually saw the swelling in their calves and ankles disappear (7). Across the board, research shows that a daily dose of 500 to 1,000 mg of Diosmin improves the health of leg veins and brings tremendous relief from pain, night cramps and leg heaviness (8,9,10,11). Both short- and long-term use of this highly effective natural ingredient comes without any side effects. It is also so safe that you need not worry about adverse interactions of Diosmin with drugs, foods, lab tests or interactions with diseases or conditions. (5). Help for Hemorrhoids Because Diosmin reduces swelling and bolsters vein health, it can also help people suffering with hemorrhoids - those uncomfortable varicose veins that form in the lower rectum and anus. Along with making it painful to sit, hemorrhoids can itch, bleed or protrude - and almost half of all Americans suffer from them by the time they turn 50 (12). Extensive research conclusively shows that Diosmin can safely alleviate the pain, inflammation and bleeding of hemorrhoids (13,14,15). Best of all, it offers quick relief, often working its magic within a week or two (16). Plus, Diosmin reduces the risk of a relapse (17). Diosmin for Cancer? While no one questions Diosmin's efficacy for treating varicose and spider veins or hemorrhoids, scientists have begun exploring other ways this potent flavonoid may boost health. Their main focus - cancer prevention - especially oral and skin cancers. Researchers haven't conclusively identified the cancer-fighting component in Diosmin, but preliminary experiments show that this flavonoid inhibits the proliferation of cancer cells (18). In two studies pitting Diosmin against other flavonoids like rutin, grapeseed extract and red wine, Spanish investigators found that Diosmin was considerably more effective at reducing the number of metastatic melanoma cells (a potentially deadly type of skin cancer cells that spread through the body) than any of the other flavonoids tested (19,20). Other studies have found that Diosmin puts the brakes on the spread of cancer cells in the mouth (25). Although it could be years before science conclusively proves Diosmin's cancer benefit, this nutrient can't be beat for supporting vein health. Along with taking supplemental Diosmin, there are several simple strategies you can employ to encourage healthy circulation. Eating a high-fiber, anti-oxidant rich diet and getting plenty of exercise can help keep veins in top form. And remember to take a break and put your feet up every now and again. References: 1. American Society for Dermatoloic Surgery. 2. National Women's Health Information Center. U.S. Department of Health & Human Services. 3. American College of Phlebology. 4. Society for Vascular Surgery. 5. Diosmin Monograph. Alternative Medicine Review. 2004;9(3):308-311. 6. Ting AC, et al. Clinical and hemodynamic outcomes in patients with chronic venous insufficiency after oral micronized flavonoids therapy. Vascular Surgery. 2001;35(6):443-447. 7. Ramelet AA. Daflon 500 mg: symptoms and edema clinical update. Angiology. 2005;56 Suppl 1:S25-S32. 8. Bergan JJ. Chronic venous insufficiency and the therapeutic effects of Daflon 500 mg. Angiology. 2005; 56 Suppl 1:S21-S24. 9. Nicolaides AN. From symptoms to leg edema: efficacy of Daflon 500 mg. Angiology. 2003;54 Suppl 1:S33-S44. 10. Smith PC. Daflon 500 mg and venous leg ulcer: new results from a meta-analysis. Angiology. 2005; 56 Suppl 1:S33-S39. 11. Jantet G. Chronic venous insufficiency: worldwide results of the RELIEF study. Reflux assessment and quality of life improvement with micronized Flavonoids. Angiology. 2002;533:245-256. 12. National Institutes of Health. 13. Lyseng-Williamson KA, et al. Micronised purified flavonoids fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs. 2003;63(1):71-100. 14. Meshikhes AW. Daflon for haemorrhoids: a prospective, multi-centre observational study. Surgeon. 2004;2(6):335-338. 15. Kecmanovic D, et al. PHLEBODIA (diosmine): a role in the management of bleeding nonprolapsed hemorrhoids). Acta Chirurgica Iugoslavica. 2005;52(1):115-116. 16. Diana G, et al. Activity of purified diosmin in the treatment of hemorrhoids. La Clinica Terapeutica. 2000;151(5):341-344. 17. Misra MC, et al. Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. British Journal of Surgery. 2000;87(12):1732-1733. 18. Browning AM, et al. Flavonoid glycosides inhibit oral cancer cell proliferation - role of cellular uptake and hydrolysis to the aglycones. Journal of Pharmacy and Pharmacology. 2005;57(8):1037-1042. 19. Martinez C, et al. Treatment of metastatic melanoma B16F10 by the flavonoids tangeretin, rutin, and diosmin. Journal of Agricultural and Food Chemistry. 2005;53(17):6791-6797. 20. Martinez C, et al. The effect of the flavonoids dioxmin, grapeseed extract and red wine on the pulmonary metastatic B16F10 melanoma. Histology and Histopathology. 2005;20(4):1121-1129. 21. Ramelet AA. Clinical benefits of Daflon 500 mg in the most severe stages of chronic venous insufficiency. Angiology. 2001;52 Suppl 1:S49-56. 22. Cyrino FZ, et al. Micronization enhances the protective effect of purified flavonoidsfraction against postischaemic microvascular injury in the hamster cheek pouch. Clinical and Experimental Pharmacology & Physiology. 2004;31(3):159-162. 23. Bergan JJ, et al. Therapeutic approach to chronic venous insufficiency and its complications: place of Daflon 500 mg. Angiology. 2001;52 Suppl 1:S43-7. 24. Katsenis K. Micronized purified flavonoids fraction (MPFF): a review of its pharmacological effects, therapeutic efficacy and benefits in the management of chronic venous insufficiency. Current Vascular Pharamcology. 2005;3(1):1-9. 25. Browning AM, et al. Flavonoid glycosides inhibit oral cancer cell proliferation - role of cellular uptake and hydrolysis to the aglycones. Journal of Pharmacy and Pharmacology. 2005;57(8):1037-1042. 26. National Women's Health Information Center. U.S. Department of Health and Human Services, Office on Women's Health. 27. Villa P, et al. Protective effect of diosmetin on in vitro cell membrane damage and oxidative stress in cultured rat hepatocytes. Toxicology. 1992;73:179-189. penis enlargement result penis elargement exercise medical penis enlargement penile enlargment supplement truth about penis enlargement pills vimax penis enlargement pic before and after penile enlargement secret penis enlargement excercises cheap penis elargement pills

Male sexual dysfunction is one of the most common health problems affecting men and is more common with increasing age. Chronic ED affects about 5% of men in their 40s and 15-25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70. In around 95% of the cases, a suitable treatment can be found. Erectile dysfunction is treatable at any age, and awareness of this fact has been growing. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for erectile dysfunction. Viagra, Levitra and Cialis Currently, there are three oral medications approved by the Food and Drug Administration (FDA) for the treatment of erectile dysfunction: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). All these agents block the enzyme phosphodiesterase type 5 (PDE-5) and belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Viagra was the first and is probably the most famous of the three PDE-5 inhibitors used to treat erectile dysfunction. Viagra was approved as an effective agent for treating erectile dysfunction in March 27, 1998. Viagra is manufactured by Pfizer, Inc. Levitra was the second PDE-5 inhibitor to come to market in the United States, and it was approved by the FDA in August 19, 2003. Levitra is manufactured by Bayer Pharmaceuticals Corporation. Cialis was the third PDE-5 inhibitor to come to market and was approved by the FDA at the end of November 21, 2003. Cialis is manufactured by Lilly ICOS LLC. The major advantage of PDE-5 inhibitors is that they do not cause an erection at inappropriate times, because they act only in response to sexual stimulation. If there is no sexual stimulation drug remains in the background. All three are taken orally prior to planned sexual activity, acting to increase blood flow in the penis in response to sexual stimulation. However, there are important differences between the three, differences that could influence safety, specificity, duration of action, adverse effects, and ultimately, public acceptance within this class of drug. Mechanism of Action PDE-5 inhibitors do not directly cause an erection of the penis, but they alter the body's response to sexual stimulation by enhancing the effect of the nitric oxide, a chemical that is normally released during stimulation. Nitric oxide causes relaxation of the muscles in the penis, which allows for better blood flow to the penile area. Effectiveness of PDE-5 Inhibitors All 3 PDE-5 inhibitors have demonstrated excellent efficacy. Viagra, at 84%, is slightly more effective than Cialis at 81% and Levitra at 80%. Pharmaceutical Forms, Onset of Action and Duration of Effect Viagra and Levitra differ only minimally in terms of their structure, while Cialis differs markedly from Viagra and Levitra in terms of its molecular structure, which is also reflected in pharmacokinetic differences. Viagra: 25 mg, 50 mg 100 mg tablets Onset of action: 30 minutes (effect delayed if taken with food) Duration of action: 4 to 5 hours Levitra: 2.5 mg, 5 mg, 10 mg, 20 mg tablets Onset of action: 25 minutes (effect delayed by fatty meal) Duration of action: 4 to 5 hours Cialis: 5 mg, 10 mg, 20 mg tablets Onset of action: 16-45 minutes (effect NOT delayed by food) Duration of action: 36 hours All three drugs require sexual stimulation to be effective. Viagra should be taken on an empty stomach it works better if you do not eat a high-fat meal around the time you take it. Levitra may be slightly less effective if you eat a high-fat meal, but a moderate-fat meal does not reduce its effectiveness. Cialis works without regard to what you eat. Viagra and Levitra have similar half-lives, and onset and duration of action. Cialis has a slower onset of action and longer duration of action, which is attributed to its longer half-life. Patients who wish for spontaneity may opt for Cialis, which may allow for successful intercourse up to 36 hours postdose, even though it takes longer to reach peak effect. The considerably longer duration of effect for Cialis will likely allow less frequent dosing and greater impulsiveness between partners, but also could potentially prolong adverse effects. Dosage The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body's ability to use the drug. Levitra is also available in a 2.5 mg dose. None of these PDE-5 inhibitors should be used more than once a day. Possible Side Effects Although all three drugs are generally well tolerated, side effects are still possible. Most common side effects: Viagra: facial flushing, headache, indigestion Levitra: facial flushing, headache Cialis: headache, indigestion Less Common Side Effects: Viagra: altered vision, dizziness, nasal, congestion Levitra: indigestion, nausea, dizziness, nasal congestion Cialis: back pain, muscle aches, nasal congestion, facial flushing, dizziness Precautions and Contraindications All PDE-5 inhibitors are absolutely contraindicated in persons who take organic nitrates. Alpha-blockers Viagra has precautionary labeling advising against taking 50 mg or 100 mg doses within four hours of taking a alpha-blocker. The 25 mg dose of Viagra has not been shown to significantly decrease blood pressure and in patients who take 25 mg of Viagra, use of any of the alpha-blockers is considered safe. Levitra is contraindicated in patients taking alpha-blockers. Cialis is contraindicated in patients taking alpha-blockers, except for tamsulosin (Flomax). Since both Viagra and Levitra have moderate vasodilatory and hypotensive effects, they should not be given in the presence of marked arterial or orthostatic hypotension, and should only be administered with caution in aortic stenosis or hypertrophic obstructive cardiomyopathy. Men who have had a heart attack or stroke within the past 6 months and those with certain medical conditions (e.g., uncontrolled high blood pressure, severe low blood pressure or liver disease, unstable angina) that make sexual activity inadvisable should not take Cialis. Dosages of the drug should be limited in patients with kidney or liver disorders. Conclusions The differences between the 3 drugs are not great. All appear to be effective and safe. Levitra has less side effects compared to Viagra and lasts about the same time as Viagra in the body. Cialis has few side effects and lasts longer in the body. This allows increased spontaneity and less frequent dosing than either Levitra or Viagra. However, the longer half-life of Cialis imposes increased risk for drug interactions.