***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study was done to evaluate the effectiveness of transdermal nitroglycerin in the treatment of  erectile dysfunction in males with spinal cord lesions as compared to the treatment with intracavernous injection of papaverine . The study design used was an open , r and omized , cross over trial of intracavernous injection papaverine versus transdermal nitroglycerin .  Twenty eight male patients with spinal cord lesions with erectile dysfunction were included in the study , and were subjected to intracavernous injection of papaverine and transdermal nitroglycerin with an interval of 2 weeks as the wash out period . Objective ly , the times taken for the onset and the duration of erection were noted . The length of the penis and its circumference at its base were measured at intervals until the erection subsided . The volume of the penis at the onset and at the peak of erection was calculated . Twenty six patients ( ie 93 % ) who received an injection of papaverine , and 17 ( ie 61 % ) of the patients who received nitroglycerin showed a complete response . The difference was statistically significant ( P=0.004 ) . Nine ( 32 % ) patients had complications with the injection of papaverine . The only complication noted with the application of a nitroglycerin patch was mild headache , experienced by six ( 21 % ) patients . It was concluded from the study that intracavernous injection of papaverine is more effective than transdermal nitroglycerin in the treatment of erectile dysfunction in patients with spinal cord lesions Study design : This was a two-part pilot study in men with erectile dysfunction ( ED ) due to spinal cord injury ( SCI : cord level range T6-L5 ) . Part I was a r and omised , double-blind , two-way cross-over study comparing a single dose of sildenafil 50 mg or placebo . Part II was a r and omised , double-blind , parallel-group evaluation of sildenafil 50 mg or placebo , taken as required ( not more than once daily ) approximately 1 h prior to sexual activity , over a period of 28 days . Objectives : To assay the efficacy and safety of sildenafil 50 mg and placebo . Setting : Clinic- and home-based assessment s in the United Kingdom . Methods : A total of 27 subjects who were able to achieve at least a grade 2 erection ( hard , but not hard enough for penetration ) in response to penile vibratory stimulation ( PVS ) were recruited . In Part I , the reflexogenic response of the penis to PVS was evaluated in the clinic while in Part II , the response to treatment was assessed in the home ( global efficacy , question niare , diary ) . Results : In Part I , 17/26 ( 65 % ) subjects had erections of > 60 % rigidity at the penile base ( median duration 3.5 min ) after sildenafil compared with 2/26 ( 8 % ) ( median duration 0 min ) after placebo ( P=0.0003 ) . In Part II , 9/12 ( 75 % ) subjects on sildenafil and 1/14 ( 7 % ) subjects on placebo reported that the treatment had improved their erections ( P<0.005 ) , and 8/12 ( 67 % ) and 2/13 ( 15 % ) men , respectively , indicated that they wished to continue treatment ( P<0.02 ) . An analysis of diary data showed no difference between the groups with respect to the mean number of erections hard enough for penetration ( P=0.08 ) . The mean proportion of attempts at sexual intercourse that were successful was 30 and 15 % , respectively ( P=0.21 ) . Similarly , responses to the end-of-treatment question naire indicated that there were no significant differences between the groups with respect to the frequency of erections hard enough for sexual intercourse ( P=0.47 ) or that lasted as long as the subject would have liked ( P=0.11 ) . No subject discontinued sildenafil due to adverse events . Conclusion : Sildenafil is an effective , well-tolerated oral treatment for ED in SCI subjects . Sponsorship : This study was funded by Pfizer Study design : Multicenter , open , prospect i ve , before-after study . Objective : To assess the efficacy and safety of sildenafil therapy for erectile dysfunction in patients with spinal cord injury , and the association between the response to sildenafil and factors such as causes and levels of spinal cord injury , grade of ASIA deficit , time since injury , orgasmic perception , and degree of baseline erection . Setting : Homes of out patients of 16 spinal cord injury units in Spain . Method : One hundred and seventy patients with erectile dysfunction secondary to spinal cord injury , from whom baseline data were collected on their sexual function , and who started treatment with sildenafil 50 mg .  An efficacy assessment was made by the patient and his partner , and the score of the International Index of Erectile Function ( IIEF ) was recorded . Results : It was reported by 88.2 % of the patients and 85.3 % of their partners that treatment with sildenafil had improved their erections , regardless of the baseline characteristics of the spinal cord injury and erectile function . In responders , this improvement was confirmed by an increase from 12.5 to 24.8 points ( P<0.001 ) of the Erectile Function Domain of IIEF . A significant improvement was also seen in patients ' satisfaction with sexual activity and general satisfaction derived from sexual life . Preservation of orgasmic perception and a baseline degree of erection of 3 or 4 ( P=0.006 ) were predictors of therapeutic success . No serious adverse events occurred . Conclusion : Sildenafil is an effective , well-tolerated treatment for erectile dysfunction caused by spinal cord injury , regardless of the cause , neurological level , ASIA grade , and time since injury . Sponsorship : Spanish Society of Paraplegia . Spinal Cord ( 2001 ) 39 , 637–643 Our experience with intracavernous injection of prostagl and in E1 in spinal cord injured patients with neurogenic erectile dysfunction included 15 men . They received testing dosage starting from 5 µg with increasing dosage ( maximum 20 µg ) to achieve a rigid erection of Schramek 's grade 5 and lasting for at least 20 min . All of them had achieved functional erection adequate for coitus after treatment except one patient who had been proved to have venogenic impotence . We found that intracavernous injection of prostagl and in E1 had significantly improved the erectile condition . No systemic side effect or any other complication was noted except that pain at the injection site was complained of in two patients with incomplete lesion Study design : A multicenter , r and omized , double-blind , placebo-controlled , flexible-dose , two-way crossover study conducted June 1996 through January 1997 . Objectives : To evaluate the effect of sildenafil citrate ( VIAGRA ® ) on the quality of life ( QoL ) of men with erectile dysfunction ( ED ) caused by spinal cord injury ( SCI ) . Setting : Study centers in Australia , Belgium , France , Germany , Norway , Sweden and the United Kingdom . Methods : Questions 13 and 14 of the 15-item International Index of Erectile Function ( IIEF ) addressed QoL issues directly related to ED in 178 men with SCI . A 5-item question naire addressing concerns that men had about their erection problems was also used to evaluate the impact of ED on QoL. Several commonly used psychometric instruments , including the Medical Outcomes Survey ( MOS ) Short Form-12 , Psychological General Well-Being Index , and MOS Family Survey , assessed general QoL issues . Results : Significant improvements were seen for overall satisfaction with sex life ( IIEF Q13 ) , sexual relationship with partner ( IIEF Q14 ) , and concerns about erectile problems ( P<0.0001 ) . Improvements were reported in scores for the generic QoL parameters of mental health , well-being , depression , and anxiety ( P<0.05 sildenafil versus placebo ) . Conclusion : Treatment with sildenafil can significantly improve key QoL parameters in men with ED caused by SCI.Sponsorship : This study was funded by Pfizer OBJECTIVE To compare the effectiveness of topically applied 2 % minoxidil to that of intracorporeal injection therapy and vacuum constriction devices for the treatment of  erectile dysfunction in the spinal cord injured ( SCI ) male . METHODS Eighteen SCI men , aged nineteen to sixty-five years ( median age , 29 ) , and level of injury C7 to L3 ( 15 thoracic level ) were prospect ively evaluated . All patients were able to achieve only a poorly sustained reflex erection that was inadequate for satisfactory intercourse . No patient had suffered erectile dysfunction prior to his SCI . In each patient , 1 mL of a 2 % minoxidil solution was applied as an aerosol spray to the glans penis . The erectile response was compared to that obtained with a vacuum constriction device ( VCD ) and intracorporeal papaverine injection . In each case , the subjective assessment by both the patient and the physician , as well as objective results of penile base rigidity as measured by the RigiScan DT Monitor Device , were recorded . RESULTS Papaverine increased rigidity at the base of the penis by a median 77 percent ( range , 30 - 100 % ) . The VCD increased rigidity by a median 57 percent ( range , 30 - 80 % ) . Minoxidil induced no change in rigidity ( range , 0 - 15 % ) . No complications were observed for any method of inducing tumescence . CONCLUSIONS Papaverine and VCD proved to be effective means of establishing penile erection in male SCI patients . Both subjective and objective erectile responses to minoxidil were poor . Nevertheless , the principle of topical therapy is an attractive alternative to existing modalities . Further investigation is warranted Erectile dysfunction is a common complication of spinal cord injury . This double‐blind , placebo‐controlled , two‐way crossover study assessed the efficacy and safety of oral sildenafil in men with erectile dysfunction caused by traumatic spinal cord injury . A total of 178 men ( mean age , 38 years ) received placebo or sildenafil 1 hour before sexual activity for 6 weeks ; after a 2‐week washout period , the men received the alternate treatment for 6 weeks . The 50‐mg starting dose could be adjusted to 100 or 25 mg based on efficacy and tolerability . Efficacy was assessed by using global efficacy questions , the International Index of Erectile Function ( IIEF ) , and a patient log of erectile activity . Of 143 men with residual erectile function at baseline , 111 ( 78 % ) reported improved erections and preferred sildenafil to placebo . For all men ( including those who reported no residual erectile function at baseline ) , 127 of 168 ( 76 % ) reported improved erections and preferred sildenafil to placebo . For all men , 132 of 166 ( 80 % ) reported that sildenafil improved sexual intercourse compared with 17 of 166 men ( 10 % ) reporting improvement with placebo . IIEF questions assessing the ability to achieve and maintain erections and satisfaction with sexual intercourse demonstrated significant improvement with sildenafil . Sildenafil was well tolerated , with a low rate of discontinuation because of treatment‐related adverse events ( 2 % vs 1 % for placebo ) . Oral sildenafil is an effective and well‐tolerated treatment for erectile dysfunction caused by spinal cord injury . Ann Neurol OBJECTIVES To assess the efficacy of intraurethral prostagl and in E1 ( alprostadil , MUSE ) in treating  erectile dysfunction in patients with spinal cord injury ( SCI ) . METHODS Intraurethral alprostadil was tested in 15 patients with SCI to evaluate its effectiveness in treating SCI-associated erectile dysfunction . All patients were at least 1 year after injury , and all had previously used intracavernosal injections successfully ( Schramek 's grade 5 erection ) . The intraurethral drug was administered in the office , in the presence of a physician , with monitoring of blood pressure . If effective , the patient was then able to use MUSE at home . The first 3 patients underwent gradual dose escalation starting with 125 microg , without the use of a constriction ring . Because of hypotension , the remaining 12 patients all used a penile constriction ring prior to intraurethral drug administration using 1000 microg . The quality of the erection was compared with that achieved with intracavernosal injections using Schramek 's grading . RESULTS The dose escalation ( titration ) in the first 3 patients demonstrated that the 1000-microg dose was the most effective in creating an erectile response . Transient hypotension was noted in these first 3 patients in whom the constricting b and was not used . The highest dose of MUSE ( 1000 microg ) was , therefore , used in the remaining 12 patients , with the constriction b and . The quality of the erection varied and appeared to be less rigid in all patients ( 12 patients with grade 1 to 3 ; 3 patients with grade 4 ) than that noted with intracavernosal injection therapy ( 1 5 patients with grade 5 ) . There was no incidence of priapism . The 3 patients with grade 4 erections tried the MUSE at home . All 3 patients were dissatisfied with the quality of the erection and did not continue to use the MUSE at home and returned to intracavernosal injection therapy . CONCLUSIONS MUSE appears to be somewhat effective in creating 
    Output:
    
Conclusions : A large body of evidence addressing sexuality in males focuses on erection .
Penile injection , sildenafil and vacuum devices generally obviate the need for penile implants to address erectile dysfunction .
Interventions may positively affect sexual activity in the short term .