Monday, April 18, 2011

The Folly of the Fertile Period.

The Folly of the Fertile Period.

The logic is, to say the very least, fatally flawed. People hold off starting a family or even getting into a relationship, until they are in their early thirties. They want to advance their careers first and a pregnancy could, at least heretofore, have throw a spanner in the works of career advancement. That’s all very understandable and laudable of course. Far be it from me to start passing judgements on these difficult and very personal decisions that we all had to make at some stage in our lives.
But here is where the flawed logic starts to click in. One day, people who have been postponing their first pregnancy for years, sit down together and decide that it may be time to start to “try” for a pregnancy. Typically such a couple may be in their early to mid thirties. Now, for some inexplicable reason, a certain urgency and immediacy seems to grip them. It’s not enough that they should discontinue whatever form or forms of family planning that they have been relying on up to this. No. In addition to this they often seem compelled to “maximise” their chances of success by confining their coital endeavours to certain times of the menstrual cycle; to the so called “fertile periods” and to adapting sexual positions also thought to help the cause along.
There are at least three serious problems with these flawed strategies. Hardly a week goes by but that I would not encounter some of them in my Internet Sexual Dysfunction Practise. The first problem is that there is no such thing as a “fertile period”. Therefore, confining sexual activity to certain times of the month, in the expectation of maximising ones chances of pregnancy, is largely a waste of time and effort. Yes, there is of course a time of ovulation but both sperm and ova can live for days and day each side of this event. Correct me if I’m wrong here but to my knowledge there is no statistical evidence to support the notion of a “fertile period”. The fact of the matter is that a pregnancy can occur at anytime during the menstrual cycle.
“Going for a pregnancy” by confining sexual activity to certain “optimal times” in the menstrual cycle also has a negative effect in that it raises the bar of anxiety all round. Suddenly love making is no longer just that. Now it has become a clinical chore and a challenge – something that needs to be done, not because it’s an end of itself but rather because it will produce a result. This is exactly the bedroom atmosphere that is designed to discourage a woman from becoming pregnant and a man from functioning properly – not the other way around.
I had a letter the other day from a young man living in Saskatoon. He writes: “ Dr. Rynne, I'm a 26 year old male recently married almost a year ago and me and my wife have been trying to have a baby. My penis works great when she is not fertile but during the few days she is and there is \"pressure\" to perform my penis sometimes goes limp or cannot ejaculate. It has progressively gotten worse.  It started out doing it towards the end of sex, today was the worse, after having sex last night my wife came home on her lunch break and we tried but my penis would not get hard. (Which has never happened before) It seems to me that this only occurs when there’s pressure to perform. I feel terrible because I feel like I’m dropping the ball on us getting pregnant...please help!”
Does this man not say it all? I rest my case.

Thursday, April 14, 2011

When is Male Masturbation Harmful

When is Male Masturbation Harmful?

The Traumatic Masturbatory Syndrome.

Woody Allen is accredited with saying about sexual self-pleasuring: “Don’t knock masturbation – its sex with someone I love”. While George Carlin remarked: “If God intended us not to masturbate, He would have made our arms shorter!” Even so, for a sexual practise, often learnedly referred as “universal”, male masturbation still has the power to engender a huge amount of guilt and even foreboding around the globe. A day scarcely goes by but that I do not have some young man seeking reassurance that his pornography watching and self pleasuring are not going to impart some irreparable damage to his potential sexual function.

Young men in particular, despite all they would have surely read about and learned in today’s information saturated world, still seem extraordinarily willing to accredit masturbation with almost mystical powers to cause anything from erectile dysfunction to premature ejaculation even to, most feared of all, infertility itself. In my enthusiasm to expunge these often irrational fears it used to be my habit to universally dismiss all concerns about masturbation. Nowadays however, my reassurances about the safety of all masturbation, is not quite so total. Now I realise that there is at least one exception to the rule that all male masturbatory practises are innocence and safe and of no real consequence.        

I refer to the practise of prone or face down masturbation where a pillow or cushion or mattress, are used to basically hump against. This is a minority practise. Kinsey, studying this subject as far back as 1948, discovered that the majority of men masturbate in the sitting up position using their hand to stroke their penis up and down. When asked, only about 12% of Kinsey’s volunteers said that they masturbated in anyway other than in the sitting up position as their majority practise. In fact when this figure is further finessed the real figure is closer to 5 to 10%. Prone masturbation as an exclusive practise is therefore rare.

This is probably just as well. It is only in the last decade or less that the dangers of developing what is today we call the Traumatic Masturbatory Syndrome is known to be directly related to the practise of using prone masturbation as an exclusive or near exclusive masturbatory technique. This syndrome often only comes to light as the boy grows into man and starts to engage in couple sexual activity. It is manifested occasionally by erectile dysfunction but more typically by delayed or absence of ejaculation from intercourse alone or a condition sometimes referred to as ejaculatory incompetence.

The reason why prone or face down masturbatory practises give rise to these unique dysfunction may be multifaceted but are probably as follows. Young men who practise prone masturbation tend to start doing so at a younger age that do those who practise sitting up masturbation. They also tend to do it more often. In the face down position the young practitioner does no ever rely on pornography simply because to do so in that position would be impracticable. Instead, he looses himself inside of  his own head and relies on the physical pleasure experienced from friction of whatever it is that’s underneath him to bring him to orgasm. These circumstances do not prevail during sitting up masturbation or intercourse and therefore failure to climax is to be almost expected in later live when couple sex becomes a feature of his life.

There are perhaps a number of points to be taken from this recent research into the Traumatic Masturbatory Syndrome. and they are:

(1)   When a man complains about ejaculatory incompetence it is now a wise practise to enquire into his ejaculatory practise history. The chances are that this will include predominately or near predominately prone masturbation.

(2)   This information arms the therapist with a scientific explanation for this sexual dysfunction and a road map for its resolution.

(3)    In advising young men about the normality of masturbation, a caveat needs to be attached to this to the effect that the position in which a man predominately masturbates is important and has at least potential implications for future sexual function. Where this is predominately practised in the prone position then the man needs to be advised that such a practise is neither safe nor sensible.       

Dr Andrew Rynne.

Monday, April 11, 2011

My Penis is Bent

Preamble. Some bending or curvature of the erect or flaccid penis is very common and hardly deserving of the status of “a condition”. About 50% of all men will have some slight bending or curvature of their penis at some stage or other of their lives. This should not be viewed as a problem nor should the man be made self-conscious about it.

Curvatures or bending; and I use both terms synonymously, may be “lateral” that is pointing to left or right. Or it may be “ventral” --  that is bending downwards or forwards, or dorsal – that is bent upwards or backwards towards the body.  Or a penile curvature may be a combination of all four directions depending on where the internal constrictions occur.
Anatomy of an Erection. Down the entire length of the penis run three spongy chambers or cylinders. To achieve an erection these spongy chambers must fill up with blood and become engorged. Running along each side of the penis we have two chambers called the Corpora Cavernosa while running along the under side there is a single chamber called the Corporus Spongiosum. All chambers are interconnected. Lining the outside of each of these spongy cylinders is an elastic stretchable membrane called the Tunica Albuginea. This is where the trouble occurs.

In order for an erect penis to be arrow straight it is necessary for all three chambers to fill up with the exact same amount of blood, under the same amount of pressure and to be held there by three separate Tunica Albuginea of exactly equal elasticity. When you think of it this way then is it hardly surprising that perfect geometrical symmetry is not always achievable?

Causes of Penile Curvature or bending.   There are mainly three causes for curvature of the erect penis. These are:

(1)   Congenital. This is the common situation where a man is borne with some asymmetry in the manner in which his erections develop. Typically, this situation, that lasts for a lifetime, does not progress. Or if it does progress it does so very slowly.

(2)   Traumatic. This is a curvature on the penis caused by some trauma to the Tunica Albuginea leading to the deposition of some fibrous non-stretchy scar tissue in that area of damage. The bend will be away from that lesion. Causes of such trauma could be the too frequent use of penile injection as a treatment for erectile dysfunction. Or another common cause might be a part-fracture of the tunica arising from some accident during sexual activity. In the majority of cases these fibrous plaques can be felt by an experience4d examiner or by the man himself.

(3)   Peyronies Disease. This term is sometimes used as a generic for all penile curvatures. That is incorrect. Peyronies Disease is a separate entity. Again, as with ALL penile curvatures the fault lies with the tunica where, for reasons not understood, there is a deposition of fibrous tissue preventing the symmetrical expansion of one or more of the spongy chambers or cylinders. Peyronies Disease may or may not be progressive.  

Treatments for Penile Curvature. Here is where you need to exercise extreme caution indeed. Particularly with the advent of the Internet, this whole area has become shark infested waters. Do a Google search on Penile Curvature and it will throw up pages upon pages for money back guaranteed ways to straighten out you bent penis. But do any of them work?

I claim no expertise in this area but I have just spent the last four hours scouring the Internet on this subject on your behalf. All my instincts as a doctor tell me that none of these expanders, or stretchers, or splints, or exercises, medicines or even injections do or can do anything at all for a penile curvature. However, I am not just informed by instincts. Two additional factors lead me to this conclusion.

(a) We have already seem that at least 95% of all penile curvature is caused by the laying down of fibrous plaque or scar tissue on the tunica Albuginea. Common sense if nothing else would seem to indicate that scar tissue is not simply dislodged by stretching or pulling. Indeed if anything it can be made worse by such futile endeavours.

(b) If any of these things worked to straighten out a crocket penis then surely their protagonists would only be too happy to demonstrate such by way of verifiable controlled clinical trial and not just anecdote. Yet search as you may, nowhere on the internet will you find anything even remotely approaching scientific evidence for the validity of these “cures”. Please correct me if I am wrong here, in the absence of such scientific evidence however I am inclined to dismiss all non-surgical conservative cures for penile curvature as entirely bogus. It’s your money at the end of the day.

Does Penile Curvature need to be treated? This of course is the real question that needs to be asked. Yes is the answer but never ever, in my opinion, for cosmetic reasons alone. Never subject yourself to penile surgery, and that’s what we are talking about, to have your penis straightened out just because you do not like the look of it or someone else does not like the look of. The risks of making things worse rather than better are just too great. As a stop-gap to formal surgery, injection of the offending scare tissue with long-acting corticosteroids may be worth considering. Again this will require careful research on your behalf.

In my opinion, the only man who should consider surgery to straighten out his penis is the one in a situation where things have progressed or seem to be progressing to where he can no longer have intercourse comfortably. As long as a man and his partner can have and enjoy intercourse comfortably then rushing into surgery is probably a mistake.

Surgery. It is very important I think that whoever is undertaking to operate on your penis to straighten it out has loads of experience in this regard and works in an accredited centre of excellence. Do not be afraid to ask the hard questions. Is the Urologist in question published for example? Do they have particular expertise in operating on penile curvature or is this something that they only occasionally turn their hand to because there is nobody else? What are their results? Can you talk to an ex-patient – very unlikely but no harm to ask?

There are two approaches to surgically dealing with the scar tissue that gives rise to the bend in you penis. One is to simply remove it and replace it with an expandable tissue graft. The other is to leave the scar insitu and fashion a shortening of the tunica on the contra-lateral side such that they balance each other out. What you should aim for is considerable and measurable improvement but not perfection because, in the majority of situations, perfection may simply not be attainable.

Keywords: Peyronies Disease. Penile Curvature. Bent Penis. Curved Penis Fractured Penis Surgery of penis. Cure my bent penis.  

Dr Andrew Rynne.

Monday, April 4, 2011

Hormone Replacement Therapy

Bioidentical Hormone Replacement Therapy.
Ever since the results of the Women’s Health Initiative study into the safety of HRT were published in 2002, people have sought safer alternatives to synthetic pharmaceutical drugs. That this should have happened is understandable. This massive study showed that women taking prescription or synthetic HRT were at an increased risk of developing breast cancer, stroke and blood clot, than were women not on such treatment.

The increased risk was small but real. Of 10,000 women not on HRT one could statistically expect 30 new cases of breast cancer to develop among them every year. If a similar group of 10,000 women were studied, only this time looking at those taking prescription HRT, one could expect 38 new cases of breast cancer to develop among them. Eight extra cases out of 10,000 women -- not very many but real nonetheless.

From this relentless yet understandable quest to find safer alternatives to synthetic pharmaceutical grade HRT has sprung an alternative industry that is a strange mixture of cult, religion and quasi-science. This is medical pseudoscience. At its heart is a Holy Grail of products called Bioidentical Hormones -- a largely meaningless term designed to impress and reassure all those attempting to Google their way to perfect health.

In establishing a religion it is always useful to instil fear at an early stage. To do this Bioequivalentologists call on the results of the Women’s Health Initiative study and talk about prescription approved HRT causing cancer, stroke and blood clot. All of which is correct of course. However there is an inference here is there not? In saying that there is an increased incidence of breast cancer for those taking FDA approved HRT it is inferred that there is no such increased risk for those taking unapproved, unproven concoctions compounded by the local chemist. Yet there is not a shred of evidence that that is the case.

On the contrary in fact. Wren and his colleagues conducted a double-blind, randomized, controlled trial on a “natural” chemist concocted progesterone cream and found that it had no effect and was not bio-available. Therefore women using this preparation while also using oestrogen are receiving no protection from developing endometrial cancer.        

As with any other religion it is a matter, not of science but of faith. All you are asked to do is to believe that Bioidentical Hormones are safer, better and more effective than their FDA approved pharmacological counterpart. This is, if you will, a central tenet of this religion, an article of faith. Bioidentical Hormones, individually run off by an approved (of course) Compounding Pharmacists are superior to those produced by an FDA approved Multinational Pharmaceutical Companies. You do not have to prove anything or produce any evidence in support of this. Like all good religions, all that is required of you is that you make an Act of Faith.

We need a few evangelists and a liturgy too of course. We need a few Gospels according to Celebrity if you like. So we are given scribes Suzan Somers and her Sexy Forever: How to Fight Fat After Forty to be follower by Hormone Balance Made Simple by Dr John Lee and for a little bedtime read you may have The Natural Superwoman by Dr Uzzi Reiss. Now parade all these authorities out in front of a global TV audiences on a regular bases and have Oprah Winfrey and Dr Christian Northrop nodding sagely in the background and you have a potent blend as good as any Bible or Koran or Torah, being beamed across the planet.

How about a little hocus pocus then as well while we are at it, a little voodoo perhaps? Yes, Bioidenticalology   has that too. They call it Saliva Hormone Assay. This is to appear to bring a bit of science to the party. The only problem is that, like most things to do with this subject, it is pseudoscience. Hormone levels in saliva are notoriously unreliable, expensive, bear no relationship to serum hormonal levels and throw no additional light on the diagnosis of menopause. Patients might feel reassured by them and doctors may feel justified in charging additional fees for them but that is as far as it goes.

Now lets create a few devils, lets get a few Lucifer’s around here – the personification of evil if you like. All religions have that don’t they? How about Horse’s Urine? Doesn’t that sound nice and nasty, kind of evil if you like? Well the next time you are riveted to some Bioidentical devotee rabbiting on about Natural Hormones check your watch and see how long it will take her to mention Horse’s Urine. What she will fail to mention is that the estrogens produced from non-vegetable sources, as for example equine estrogens, are converted in the human body into human estrogens, they are in fact Bioidentical at their point of action. In any case most prescription HRT is manufactured from vegetable sources such as the yam the so-called “natural” source the Bioequivalentologists would like to claim as their very own.

Another useful hate figure for this religion is the Multinational Pharmaceutical Industry. And while I’m no apologist for them, it is a bit rich I think to be wagging a finger at them while at the same time eulogising the activities of a network of compounding chemists and saliva analysers who collectively also constitute a similar Multinational Pharmaceutical Industry. The only real difference is that the former are required by law to comply to stringent rules and regulations while the latter are free to do whatever they like.  

At the end of the day the choice is yours. I carry no brief for anyone. Which would you prefer? To visit a doctor well versed in the art of hormone replacement therapy for women. To take under professional supervision a range of substances manufactured to strictly enforced GMP, proven in clinical trials to be absorbed into your body, proven in clinical trials to be effective, proven in clinic study to have a definitive range of dangers and made from “natural” ingredients.

Or would you perhaps prefer to trust a zealot and have your saliva analysed? Would you then take the word of some stranger in an unregulated laboratory to diagnose your menopausal condition? Would you then be happy to commit to a range of substances compounded without supervision or regulation, with no established bio-availability, no proven efficacy, no definitive range of dangers or side effects and made from the self same “natural” ingredients? Now you tell me.         

Doctor Rynne

Saturday, April 2, 2011

Doctor Andrew Rynne: Hormonal Replacement Therapy for Women - Do women ...

Doctor Andrew Rynne: Hormonal Replacement Therapy for Women - Do women ...: "Hormonal Replacement Therapy for Women. Do women need testosterone? Dr Andrew Rynne. Up to the year 2002 hormone replacement therapy o..."

Hormonal Replacement Therapy for Women - Do women need testosterone

Hormonal Replacement Therapy for Women.

 Do women need testosterone?

Dr Andrew Rynne.

Up to the year 2002 hormone replacement therapy or HRT was almost standard treatment for all post-menopausal women suffering from symptoms of falling female sex hormone levels. Up to then, testosterone was not considered a female sex hormone of any significance. In the past ten years there have been some quite dramatic developments.

What are the most frequent symptoms of Menopause?

(1)   Frequent hot flushes.
(2)   Night sweats.
(3)   Vaginal dryness making sexual activity difficult or impossible.
(4)   Loss of libido and mild depression.
(5)   Hair and skin dryness.
(6)   Weight gain unrelated to over-eating.
(7)   Slowing down and eventual cessation of menstruation. Erratic menstrual periods.

What hormone levels fall at time of menopause?   

All female hormonal levels, including testosterone, fall around the time of menopause but the ones that cause the most symptoms are oestrogen, progesterone and testosterone. Testosterone is a steroid androgen hormone produced by the ovaries and adrenal glands. During early adulthood women produce testosterone at about 10% the rate that men do. As with men also, their levels of testosterone fall as they get older such that by menopause, or shortly thereafter, their testosterone levels fall to zero or near zero.

Testosterone levels in women.

Testosterone is now thought to play an important role in female libido and sexual response. Not all women, by any means, will experience a fall in their sex drive or function as a result of declining testosterone levels. Some however will and it is important to know that these women can be helped and need to be helped.  

Can these be replaced?

Yes, all three hormones can be replaced. In the case of post hysterectomy, oestrogen can be given alone since endometrial cancer is no longer a possible side effect. Otherwise a combination of oestrogen and progesterone are usually chosen since oestrogen given alone carries a greater risk of endometrial cancer. Testosterone, so often forgotten, can now be given alone or in combination with either of the other hormones.

What are the treatments for menopause?

The most effective treatment for menopausal symptoms remains hormone replacement therapy. If you have not had a hysterectomy this will involve a combination of oestrogen and progesterone and perhaps testosterone. If you have had a hysterectomy, because that removes the danger of endometrial cancer, the estrogens alone or in combination with testosterone, will be your treatment of choice.

In 2002 the preliminary findings of the Women’s Health Initiative study were reported to a fanfare of alarming publicity. The bottom line was often misinterpreted in attention grabbing headlines like: HRT CAUSES BREAST CANCER.   However, it might be useful to understand exactly what the study did in fact report:

Among 10,000 women taking oestrogen/ progesterone combination HRT for one year there were eight extra cases of breast cancers when compared to a similar group of women not receiving HRT over one year. The initial study did not show any extra deaths among the HRT taking women.

Other facts that sometimes hysterical reports on this study failed to mention was that there was a decreased incidence of bone fracture and of bowel cancer among the HRT group. And also there was a 15% reduction in the incidence of breast cancer among women who were on oestrogen only HRT – that is, post-hysterectomy women.  

There were 38 cases of breast cancers among the HRT group compared to just 30 cases among the non HRT group. The question then that a woman needs to ask herself is this. Are the benefits of my taking HRT such that they outweigh the increase in the risk of developing breast cancer? This question needs to be answered in the calm light of day and not be unduly influenced by devotees on either side. Is the risk versus benefit ratio correct? Are my menopausal symptoms such that to be rid of them would be well worth the risk of being one of those 8 in 10,000 women for whom this treatment might cause breast cancer?

To add even more worry to this vexed question The Women’s Health Institute study also showed an increased risk of developing heart attach and stroke among the HRT group of approximately the same increased rate of some 10 extra women per 10,000 on treatment. Again this figure needs to be looked at in a balanced fashion for what it is and risk/benefit ratio needs to be weighed up.  

What about Natural or Bioidentical HRT.
Much play has been made in recent years about the virtues of naturally occurring hormones as distinct from the synthetic ones. Indeed a major industry has grown up around this very topic. Some very fashionable and famous women have thrown themselves behind the argument in favour of “naturally occurring” HRT. Unfortunately though, this is invariably accompanies by far more hyperbolae than clinically proven fact, anecdote rather than study.  The problem is, search as you may, there are no published studies that I am aware of, that actually prove that naturally occurring hormones impart any benefit over the synthetic ones and may do not carry the same efficacy.

Hormone replacement therapy (HRT) for women today remains every bit as valid and as useful as it always has been. It has now been extended to considering the addition of testosterone to oestrogen and progesterone. As always, care must be exercised and this therapy should only be embarked upon under medical supervision and advice. In our present knowledge so called “Bioidentical” HRT offers no advantage over their synthetic equivalents and indeed may not be as effective.   

Article by Doctor Rynne: