If Someone Did Not Have Parkinsons Before Is It Likely That They Will Develop It After Recovering From Covid
Dr. Okun: We do not have the numbers on how common it is to receive a Parkinson’s diagnosis after recovering from COVID-19. There are several intriguing papers on how COVID-19 may affect the brain and how it may possibly contribute to Parkinson’s risk. At this point, we caution the public and researchers not to speculate until we have more data.
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The study “Impulsivity and Parkinson’s disease: More than just disinhibition,” published in the Journal of the Neurological Sciences, provides an excellent discussion of the topic, as does the chapter “Impulse Control Disorders,” by Valerie Voon and Susan Fox, in the book “.” These authors point out that PD and the medications used to treat it directly affect the neural pathways used to regulate attention and impulse control. Any type of impulse can be affected.
Those with poor impulse control prior to PD onset were more likely to have more severe impulse control problems after PD onset. The contrary also is true. Those who practiced impulse control were less impacted. Our rehab to deal with impulsivity needs the daily practice of impulse control.
The above graphic is a representation of the cognitive pathways involved and the checkpoints we can become mindful of when developing a rehabilitation plan to address impulsivity. The arrows represent the flow of data or information into our brain .
Step two is impulse checkpoint awareness and adjustment. There are three checkpoints, and all three affect the perception of information coming into our brains. Thus, they affect impulsivity.
Checkpoint one is a background noise filter. Our brains don’t consciously process everything that the senses pick up. Think of all the noises, sights, and smells that are around you every day. Normally, you do not attend to them all and do not remember them all. Your brain filters them.
I Have Parkinsons And Blood Pressure Issues Should I Be Worried About Getting The Vaccine
Dr. Okun: No. You will most likely be sitting when you get the vaccine, so if you get faint or have a change in your blood pressure you should be okay. Stay hydrated; it will help with changes in blood pressure. Take a water bottle and a snack with you. You will likely be asked to sit in a waiting area for 15-20 minutes after each shot to make sure you do not have a reaction. If you can drink a small bottle of water either immediately before or immediately after the shot, we believe this is a good idea, especially if prone to fainting.
Implications For Biomarkers In The Prediction And Early Diagnosis Of Parkinsons Disease
Cumulative cellular damage in patients with PD can be found in skin fibroblasts, and the PINK1 and Parkin genes are expressed at relevant levels in human fibroblasts.2 Moreover, fibroblasts from patients with idiopathic PD show a clear and distinctive mRNA expression pattern of key genes in neuro-degeneration,2 and increased risk of PD is found in specific genotypes. For example, a case–control study including 272 cases and 1185 controls found that participants with the Cys/Cys genotype had a higher risk of PD.21 This specific genotype is associated with red hair, thus suggesting a potential role of pigmentation in PD.21
Conclusively, as early pathology is not only found in the brain but possibly also in extra-neuronal tissues such as the skin, it is tempting to speculate that skin biopsies may be used for PD diagnosis in the future.2 In addition, origins of skin-derived precursors may serve an alternative source of stem cells to embryonic stem cells for transplantation therapy for PD.46
What Do People With Parkinsons Need To Bring With Them For Their Vaccine Appointment
Dr. Okun: Take your personal information and medication list. If you are prone to fainting, let the nurse know. For the second shot, bring the card issued to you on the first shot, so that the vaccine administration can be documented. Take a picture of the card once you have both shots so that you always have a copy.
Q Other Than Difficulties With Movement Are There Any Other Physical Symptoms
A. Other problems – so called ‘non-motor symptoms’ – are common and can have a major effect on quality of life. These symptoms can occur at any stage of the condition and can even start before movement symptoms are noticed.
Non-motor symptoms include:
- sensory symptoms , which occur in up to 40 per cent of people with the disease;
- tiredness not relieved by resting ;
- sleep problems , which affect about 70 per cent of people;
- constipation, which is due to the digestive tract slowing down and decreased mobility;
- bladder problems that can result in needing to urinate urgently and/or more often, urinary incontinence or difficulty urinating;
- orthostatic hypotension , which causes a sudden fall in blood pressure when changing positions – usually standing up – causing fainting ; and
- depression and anxiety, which are not just due to having a chronic illness but are part of the disorder.
Constipation , urinary problems and sleep problems can be made worse by some of the medicines used to treat Parkinson’s disease.
Q What Are The Different Types Of Medicines Used To Treat Parkinsons Disease
A. Because the symptoms of Parkinson’s disease are caused by a lack of dopamine in the brain, most drug treatments — so-called ‘antiparkinsonian medications’ — are aimed at replacing dopamine, prolonging its action or acting like dopamine.
Levodopa, also known as L-dopa, is the most effective medication available, improving symptoms in more than 80 per cent of people within 6-8 weeks. Levodopa is converted into dopamine by nerve cells in the brain. To prevent it from being converted to dopamine before it reaches your brain, it needs to be given in combination with another medication . These combination medications are called Sinemet and Madopar, respectively.
Other medicines available for the treatment of Parkinson’s disease include dopamine agonists, MAO-B inhibitors, COMT inhibitors, anticholinergics and amantadine. Although these medications are generally not as effective as levodopa, they do benefit some people. They are especially useful if levodopa is causing intolerable side effects or isn’t controlling symptoms on its own. These medicines are often used as initial therapy to control relatively mild symptoms, especially in younger patients.
A range of treatments is also available for non-motor symptoms such as depression, sleep problems, constipation and sexual dysfunction.
Q Are There Any Problems Associated With Using Levodopa In The Long Term
A. The use of medications means that most people with Parkinson’s disease can expect many years of active living. Unfortunately, the initial positive response to levodopa does not always last — its effects often become unpredictable, and various side effects start to appear after about 5 years of treatment. The main side effects associated with long-term levodopa therapy are dyskinesias and the ‘wearing-off’ effect.
Dyskinesias are involuntary twitching and jerking movements of the head, face and limbs. These uncontrolled movements are the most common adverse effect of prolonged levodopa therapy. Taking a lower dose of levodopa or combining levodopa with another antiparkinsonian medication — a dopamine agonist — may improve the problem of dyskinesia.
The ‘wearing-off’ effect, or end-of-dose failure, refers to a decrease in the length of time that each dose of levodopa controls symptoms. This results in periods of impaired movement that abruptly alternate with periods of improved mobility.
Taking smaller, more frequent doses of levodopa or controlled-release levodopa can help. There is a formulation of levodopa plus carbidopa that can be used in people with more advanced Parkinson’s disease who have severe fluctuations in response to levodopa. The medicine is a gel that is given directly to the small intestine via a feeding tube. By giving the medicine continuously through a feeding tube, the amount of medicine in the body is constant, reducing the wearing-off effect.
Q What Lifestyle Adjustments Can I Make To Help Improve My Symptoms
A. Although there are medications which are very effective for treating the symptoms of Parkinson’s disease, the effects of these medications usually diminish with time. For this reason, your doctor may recommend some lifestyle changes before starting you on medication.
Regular exercise can help you to maintain flexibility and mobility. It also improves posture, balance, strength, agility and even mood. A moderate level of exercise is best — try walking, swimming, tai chi or dancing. Always remember to ask your doctor about an appropriate fitness programme before you start.
Loss of appetite and subsequent weight loss can occur as a result of depression or a decreased sense of smell. Try to maintain a healthy and nutritious diet, with plenty of fibre to prevent constipation. Your doctor may need to prescribe an antidepressant medication if depression is severe or contributing to poor appetite and weight loss.
Q How Can I Stop Parkinsons Disease Affecting My Everyday Life
A. The problems with movement do affect everyday life, but with the help of health professionals you should be able to make adjustments to your daily routine and alterations around your home to help keep you active and independent.
- Speech can become monotonous, slurred or soft, and some people stutter if they have difficulty articulating words. A speech therapist can suggest verbalisation exercises and tongue movements to help you to speak louder and enunciate more clearly.
- As the disease progresses, you may find that eating becomes difficult due to problems with chewing and swallowing. A speech therapist may also be able to help with these problems.
- You may find walking difficult, especially taking the first step. A physiotherapist can give you exercises to strengthen your muscles and improve flexibility, as well as tips on how to improve posture, balance and mobility. Installing railings in the bathroom and hallways or using a walking aid can also help, and removing rugs from your home can prevent tripping.
- There is footwear available that can help improve gait and balance problems, and clothes with fastenings that should be easy to manage . An occupational therapist can help with suggestions and devices to make everyday tasks easier.
- Your handwriting can become small, shaky, and eventually illegible due to the combination of tremor, rigidity and bradykinesia. Using a large-body pen or pencil or a felt-tip pen may help.
Signs Of The Protein Accumulating Around Nerves In The Skin
The researchers had a hunch that they might find earlier signs of Parkinson’s by looking at the autonomic nervous system in the skin, and at alpha-synuclein, in particular.
There is already a view that symptoms connected to the autonomic nervous system, such as changes in temperature and blood pressure regulation, and bowel function, may precede the motor system symptoms seen in people with Parkinson’s.
Autonomic nervous system changes also occur in the skin, such as excessive or diminished sweating, changes in skin color and temperature. These symptoms occur in nearly two-thirds of patients with Parkinson’s disease , says Prof. Freeman.
“The skin can provide an accessible window to the nervous system and based on these clinical observations, we decided to test whether examination of the nerves in a skin biopsy could be used to identify a PD biomarker,” he adds.
Impulsivity And Parkinsons: The Itch That Must Be Scratched
Impulsivity is a symptom commonly associated with both Parkinson’s disease and some of the medications used to treat it.
Impulsivity involves acting on urges with little thought to the consequences — that seven-year itch that feels like it must be scratched — regardless of the problems that may arise. Impulsivity takes many forms. My previous columns about terror and irritability both speak to issues centered around impulsivity.
The cognitive pathways that involve impulsivity are simplified in the graphic below with the important checkpoints labeled as CP.1, CP.2, and CP.3. These checkpoints are where the impulse signals are heightened. The more heightened they become, the more difficult it is to alter their eventual destination of impulsive action.
PD creates problems at these three checkpoints and thus creates the false perception of heightened signal input and the false impression that it is the itch that must be scratched. Recognizing this is the first step in a rehab plan.
Skin Issues Are Common Among Those With Parkinsons Disease
Most of us know or have known someone affected by Parkinson’s Disease.
Each year, more than 60,000 people are diagnosed with Parkinson’s, which is a progressive neurological condition.
In the United States, more than a million people live with Parkinson’s disease. Statistics show men are more likely to develop it than women, and it usually occurs as we get into our 60s or 70s.
Some patients can experience slowness, tremors or balance problems. Others may experience decreased expressions in facial muscles, speaking softly, smaller handwriting than in the past, difficulty sleeping or constipation.
Not only does it affect the neurologic system, but it can affect the skin.
Various skin manifestations seen in Parkinson’s disease are seborrheic dermatitis, dry skin, excess sweating and an increase in skin cancer development.
Changes in the skin are common symptoms of Parkinson’s disease. Many patients with Parkinson’s can develop oily or flaky skin, especially on the face and scalp. This is a common skin condition in the general population but more prevalent in patients with Parkinson’s. It is referred to as seborrheic dermatitis.
For unknown reasons, seborrheic dermatitis is associated with an increased risk of Parkinson’s disease. Patches of scaly, red skin, also referred to as dandruff, occurs primarily on the scalp and on the oily parts of the face such as the sides of the nose.
Q Is Surgery Beneficial For People With Parkinsons Disease
A. Neurosurgery is increasingly used for people who have erratic and disabling responses to prolonged levodopa therapy. Options include deep brain stimulation , pallidotomy and thalamotomy. These procedures are generally only available in large, specialist centres.
Deep brain stimulation is where electrodes are inserted in the parts of the brain that control smooth motor control. These electrodes are connected to a device that is implanted under the skin near your collarbone.
The main difference between deep brain stimulation and traditional surgery is that you are able to activate and control the device, which sends tiny bursts of electricity to your brain to help control tremor and dyskinesias.
For people taking levodopa, it can help stabilise medication fluctuations and dyskinesia. Rigidity and bradykinesia can also improve with this treatment.
Unfortunately, this procedure is generally not helpful for people who have not responded to levodopa, except for those whose main symptom is tremor. Deep brain stimulation is not suitable for people with dementia, a psychotic illness or a major medical condition.
Pallidotomy, which involves destroying overactive cells in a region of the brain called the globus pallidus, is generally reserved for people with advanced disease that is not controlled by medicines. It can also treat the dyskinesias that result from long-term levodopa therapy, and allow continued use of levodopa.
Do People With Parkinsons Get Priority Access To The Covid
Each state has its own process for rolling out the vaccine to different population groups. If you would like to advocate for people with Parkinson’s to be part of a priority group, we encourage you to contact your elected officials. We have created a letter that you can personalize and send them either by mail or electronically.
Main Component Of Abnormal Protein Clumps In Brain Cells
Alpha-synuclein occurs throughout the nervous system, and although we do not know much about what it does, scientists have found it is the main component of the abnormal clumps of protein or Lewy bodies, that form inside the brain cells of people with Parkinson’s disease. There is also growing evidence to suggest the protein plays a key role in the development of the disease.
Prof. Freeman says:
“Alpha-synuclein deposition occurs early in the course of Parkinson’s disease and precedes the onset of clinical symptoms.”
Q What Is The Outlook For People With Parkinsons Disease
A. Most people can continue to work full time and lead relatively normal lives for many years after being diagnosed. The disease does not affect your life expectancy, and your age at diagnosis does not seem to have any effect on your long-term outlook. However, due to the progressive nature of the disease, many people do eventually become disabled.
Side Effects Not Requiring Immediate Medical Attention
Some side effects of lorazepam may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
- decreased interest in sexual intercourse
- disturbed color perception
- feeling of constant movement of self or surroundings
- hair loss or thinning of the hair
- halos around lights
- inability to have or keep an erection
- increased in sexual ability, desire, drive, or performance
- increased interest in sexual intercourse
- lack or loss of self-control
- loss in sexual ability, desire, drive, or performance
- muscle aches, twitching, or weakness
- night blindness
- shakiness in the legs, arms, hands, or feet
- trembling or shaking of the hands or feet
- tunnel vision
Applies to lorazepam: compounding powder, injectable solution, intravenous solution, oral concentrate, oral tablet
Cutaneous Adverse Effects Of Neurological Medications
While allergic cutaneous reactions to dopaminergic drugs are very rare, few cases of skin rashes have been reported following the use of Sinemet® compounded with yellow dye. As rashes were not reported with other tablet sizes of this drug containing blue dye, the yellow dye used in that specific preparation was suspected as the offending compound.4,38 The cases reported maculo-papular rashes on the trunk and arms, which resolved following discontinuation of carbidopa/levodopa and reoccurred when the drug was reintroduced.
As various cutaneous effects may occur following the use of anti-PD agents, thorough patient information and regular monitoring by treating physicians is advised. Discontinuation of treatment can cause motor symptoms such as tremor and dyskinesia, but continued therapy following cutaneous reactions may potentially worsen the physical and mental conditions of patients with PD. Consequently, a personalized treatment approach is, therefore, recommended.
Im Allergic To Other Vaccines Should I Get The Covid
Dr. Okun: In many cases, people with allergies to vaccines may possibly receive the Moderna or Pfizer vaccines. Side effects including allergies to vaccines are usually caused by the fluid surrounding the vaccine itself. Do not assume you cannot get this vaccine; talk to your doctor. Old fashioned vaccines are manufactured in a completely different fashion as compared to the current COVID-19 vaccinations. It will be rare for someone to not be able to receive the vaccines; we believe most people are eligible.
What Are The Differences Between Available Vaccines
Dr. Okun: Moderna and Pfizer vaccines are distributed in the U.S. and in other countries, with 94 and 95 percent effectiveness. Both require two dosages and need to be stored at incredibly low temperatures — the Pfizer vaccine requiring an even lower storage temperature than the Moderna vaccine — making distribution and storage a challenge. These two vaccines belong to a new treatment approach called messenger RNA vaccines, which create a COVID-19 defense system.
Other vaccines are in development around the world and most work more like a traditional vaccine . They send instructions through DNA, teaching the immune system how to respond to COVID-19. There are several vaccines in early development, but these have the most available information:
- Oxford–AstraZeneca: distributed in the U.K. with ~70 percent effectiveness. It works in two dosages. The major benefit to this vaccine is that it can be stored at refrigerator temperatures. The vaccine may be more effective if a weakened first shot is followed a few weeks later by a standard dose.
- Sinovac and Sinopharm: created in China with ~78-80 percent effectiveness using two dosages. There is limited data on these vaccines. Sinovac is currently in late-stage trials in other countries.
- Sputnik V: distributed in Russia and works using two dosages. Early reports are of ~92 percent effectiveness. However, there is limited data on this vaccine.
Side Effects Requiring Immediate Medical Attention
Along with its needed effects, lorazepam may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking lorazepam:
- blood in the urine or stools
- bluish lips or skin
- confusion about identity, place, and time
- difficulty with breathing or swallowing
- difficulty with speaking
- fever with or without chills
- general feeling of tiredness or weakness
- irregular, fast or slow, or shallow breathing
- loss of interest or pleasure
- loss of memory
- lower back or side pain
- muscle pain or cramps
- pale or blue lips, fingernails, or skin
- pinpoint red spots on the skin
- problems with memory
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- reddening of the skin, especially around ears
- sores, ulcers, or white spots on the lips or in the mouth
- stiffness of the limbs
- swelling of the eyes or inside of the nose
- swelling of the face, ankles, or hands
- swollen glands
- thoughts or attempts at killing oneself
- tightness in the chest
- uncontrolled movements, especially of the face, neck, and back
- unexplained bleeding or bruising
- vomiting of blood
- yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur while taking lorazepam:
Symptoms of overdose
Treatment Of Skin Problems In Parkinsons Disease
- For oily and greasy skin, standard treatments, such as using a neutral soap and washing the skin twice daily with warm water and rinsing with cold water, do help. It is preferable to use gels since they are water based, than creams which are oil based. In more severe cases, a cream containing sulfur and salicylic acid may give better results.
- Various lotions and shampoos are available for treatment of dandruff. Selenium or selenium sulfide containing products may give good results.
- Seborrheic dermatitis may need treatment with lotions containing a steroid such as adrenocorticotrophic hormone, or a ketoconazole containing cream. Coal tar shampoo may be effective for forehead and eyebrows.
- Taking lukewarm showers, wearing light cotton clothes in summer, and drinking plenty of water and liquids are helpful in combating the effects of excessive perspiration. Excessive sweating may sometimes be due to side effects of anti-Parkinson drugs such as levodopa or can occur during the “wearing off” period of levodopa treatment -adjusting the dose, using a controlled release levodopa preparation, or COMT inhibitors may help. Beta-blockers, anticholinergics, or use of astringents containing glutaraldehyde also help in some cases.
- Too little perspiration may be helped by reducing the dose of anti-Parkinson medicines such as anticholinergics.
What Should I Avoid While Taking Trihexyphenidyl
Use caution when driving, operating machinery, or performing other hazardous activities. Artane may cause dizziness or blurred vision. If you experience dizziness or blurred vision, avoid these activities.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking Artane.
Avoid becoming overheated. Artane may cause decreased sweating. This could lead to heat stroke in hot weather or with vigorous exercise. Try to keep as cool as possible and watch for signs of heat stroke such as decreased sweating, nausea, and dizziness.
Msg Sensitivity : Causes Symptoms And Treatment
Monosodium glutamate can be found as a flavor-booster in many packaged foods and restaurant dishes where it enhances the taste of food by stimulating nerves on the tongue and in the brain. It is especially popular in Asian cooking but is also commonly used in processed meats, canned vegetables and clear soups.
Monosodium glutamate is the sodium salt of glutamic acid, a white, crystalline salt-like substance. The body uses the carboxylate anion of glutamic acid known as glutamate to help transmit messages within the brain. Glutamate is present in all foods that contain protein.
MSG is made from fermenting sugar beets, sugar cane, corn, molasses or tapioca and is considered a safe additive by the FDA when “consumed at customary levels”. The FDA stated that no evidence exists to suggest that MSG causes the brain damage that could trigger Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis or any other chronic disease. However, some people are sensitive to MSG and some critics believe that MSG is an excitotoxin, which contributes to a number of long-term conditions affecting the brain.
The FDA further stated that people who chronically suffer from adverse reactions to MSG are “MSG sensitive” or “MSG intolerant”, a condition called MSG symptom complex .
Should I Worry About A Severe Allergic Reaction
Chronic hives are usually not associated with any serious allergic reactions. These emergencies, also called anaphylaxis, are dangerous, potentially life-threatening allergic reactions requiring medical treatment. Hives resulting from anaphylaxis often occur with other symptoms, such as difficulty breathing, dizziness, and swollen eyelids, lips, and tongue. If you experience any of these symptoms along with hives, call 911 immediately.
Chronic hives can be difficult to live with, but there are effective treatment options to help manage symptoms. Identifying and avoiding triggers is also key to managing chronic hives. And after making a positive diagnosis, your doctor will suggest one or several treatments that may be beneficial to you.
Causes Of Skin Problems In Parkinsons Disease
Skin problems may occur as a result of Parkinson’s disease and improper functioning of the autonomic nervous system, or sometimes as a side effect of anti-Parkinson drugs.
- The sebaceous glands in the skin produce sebaceous matter or sebum, which help to protect the skin and keep it supple. Excessive production of sebum may occur in Parkinson’s disease and the areas that contain more sebaceous glands, such as on the forehead, beside the nose, and scalp are more severely affected. This causes oily skin and dandruff and in extreme cases the skin may become red, inflamed and itchy. Heat may exacerbate this problem.
- In Parkinson’s disease, sweat glands may produce too little or too much sweat, causing problems of dry skin or excessive perspiration. Anti-Parkinson drugs also have side effects causing too much sweating , or too little sweating .
Secondary Parkinsonism Vs Parkinson’s Disease
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Types Of Skin Problems In Parkinsons Disease
- Oily skin. There is excessive oiliness of the skin on the face, especially on the forehead and on the sides of the nose, making the skin look greasy and shiny.
- Dandruff. The scalp may become oily, resulting in greasy hair and dandruff.
- Seborrheic dermatitis. Inflammation of the skin may occur, causing the skin to become red and itchy, with a tendency to flake.
- Dry skin. In some cases there is extreme dryness of the skin due to too little perspiration.
- Excessive sweating. Too much perspiration can be a distressing symptom.
- Night sweats are quite common in patients with Parkinson’s disease.
Allergic Reaction Versus Parkinsons Disease
Allergic reaction is tied to the immune system. It responds when otherwise safe substances enter the body but are incorrectly identified as harmful “foreign bodies.” The immune system’s job is to protect us from illness, including viruses, bacteria, infection and disease. When the immune system overreacts, a large amount of histamine is released in an attempt to protect our body from attack. Histamine is a key defender against “foreign bodies” that could cause us harm. It fights infection and disease but also causes inflammation, which creates many symptoms of allergy including shortness of breath, itchiness, swelling and hives.
Dopamine is a transmitter neuron that sends signals to other neurons that control pleasure, sensation and movement. It’s found in large concentrations in the substantia nigra, in the brain. In Parkinson’s Disease, dopamine response is very low. Motor function symptoms of Parkinson’s tend to show up when 60-80 percent of the cells that produce dopamine are damaged or otherwise not producing sufficient levels dopamine. The main early symptoms of Parkinson’s Disease include stiff muscles, slow movements, tremors and trouble with walking and balance. Non-motor symptoms of Parkinson’s include congested nasal passages, difficulty swallowing or breathing, and dermatitis . Non-motor symptoms of Parkinson’s and symptoms of allergy can be very similar.
Q Can Parkinsons Disease Affect My Sex Life
A. Reduced libido and impotence can result from physical and/or psychological factors of Parkinson’s disease. In addition, some of the medicines used to treat the symptoms of Parkinson’s disease can cause sexual dysfunction in men, and vaginal dryness in women. Fatigue can make matters worse.
It may help to try having sex in the morning after taking your medication. Medicines are available to help men with erectile difficulties, and vaginal lubricants may be of help to women.