Sunday, August 21, 2011

Codeine. An Unusual Cause of Ejaculatory Failure

Codeine. An Unusual Cause of Ejaculatory Failure.
Dr Andrew Rynne.

Delayed ejaculation or so-called anorgasmia is a common male sexual dysfunction. In order of frequency it comes third to erectile dysfunction and premature ejaculation. It can be a deeply frustrating and devastating problem for which there are many causes. Drugs, both illicit and prescribed are common culprits. Common among the latter are all antidepressants and all antipsychotics. Not so well known however is Codeine. This over the counter addictive medicine is a major cause of ejaculatory incompetence. Yet very few people seem to realise it.

Just because it’s easy to get – usually without a prescription, this does not mean that codeine is just another Headache Medicine like paracetamol or aspirin.  Far from it!  Codeine is classified as an opioid. In other words its effects are not on the peripheral nervous system but on the brain chemistry itself. Any drug that has the potential to interfere with brain chemistry also has the capacity to bring about some serious sexual dysfunction and other problems..

Think of it this way: Messages are constantly been sent around your central nervous system via chemical known as neurotransmitters. This sophisticated communications system relays feelings of pleasure from your penis up to your brain. When your brain has had sufficient of this it relays a message to your ejaculatory ducts to ejaculate or reach orgasm.
But like all sophisticated systems it is easy to upset it.

Any drug that has a central brain action and the capacity to alter brain chemistry can also cause major disruption to messages to and from the brain. This in turn brings about a numbing of feelings from penis to brain such that the brain is insufficiently stimulated to respond with a message to ejaculate. When this happens there is but one solution – discontinue taking the offending medicine.
Indeed there are many other good reasons to discontinue taking codeine on regular bases.  It is addictive. It causes a strain on your liver. And now as we have seen, it can cause major disruption to healthy sexual functioning. I have found in practise that it is sometimes very difficult to sell this idea of discontinuing codeine. Like nicotine and all addictive substances, codeine infuses in its victims a built-in resistance to the notion of quitting.

And yet quitting is not difficult if taken in easy bite-sized stages. By reducing the dose by 1/10 th per week over ten weeks most people succeed in quitting very easily. And just look at the advantages! Release from the tyranny of having to take a drug every day is one. Reduction of chronic liver damage is another. And now as we have just seen, return of normal healthy sexual functioning is perhaps greatest of all.

More information available at:

Monday, August 8, 2011

Understanding Performance Anxiety Erectile Dysfunction

Understanding Performance Anxiety Erectile Dysfunction.

Performance anxiety is the commonest cause of erectile dysfunction in young men. This applies across all cultures, socio-economic groups and educational levels reached. It is a universal fact. And still it remains poorly understood. Most men, on being told that their problem is performance anxiety, want to reject such a suggestion and want you the doctor to come up with an alternative diagnosis. Sometime even the consultation can end in conflict.

In order to become sexually aroused a man’s subconscious brain needs to send a message to his penis. This signal is to ask the penis to fill with blood and get ready for action. If in the meantime the man’s mind is entertaining negative thoughts, however slight or niggling, about the state of his penis, then these subconscious messages are blocked and no erection results. For the system to work there must be no negative thoughts whatsoever. Only desire and relaxed pleasure work.

When a doctor tries to explain this to a man the patient’s immediate reaction often is to reject any such suggestion. He does this because he makes the following incorrect assumptions:

• Performance anxiety is the man’s own fault. That is not correct.
• Performance anxiety is difficult to treat. That is not correct.
• Performance anxiety is a sign of weakness and only affects wimps. That is not correct.

What young men often do not seem to understand is that all other causes of erectile dysfunction, in their age group, are relatively rare. These would include things like venous leek -- extremely rare in my experience. Indeed I have never seen a case in all my years of medical practise. Diabetes – very easy to rule in or to rule out. Medications or drug abuse – again easy to exclude.  Neurological diseases or other chronic illness. Again this should be blindingly obvious as a cause of ED. In short, nine times out of ten, performance anxiety is the candidate of first choice but is often the one that is most difficult to sell.

Doctors or counsellors who would assume to treat sexual dysfunction in younger men need to be very aware of how the notion of performance anxiety can often be met with hostility. Often indeed it is necessary to come at this diagnosis via a circuitous rout. It is often wise to list all possible causes and to rule them out one by one such that the client is left with on reasonable alternative explanation for his problem other that to accept the cause as being our old friend, performance anxiety. Because until such time as this acceptance begins to dawn on him, there can not be any cure.

For more information about performance anxiety please visit

Online Medical Consultation Here to Stay

Online Medical Consultation Here to Stay.

Being in General Practise for thirty years or more has, as you can imagine, thought me a thing or two about people and their relations with doctors. Here are some of the things I learned:

• People often don’t trust doctors but are afraid to challenge them. They are afraid to ask for a second opinion.
• People often don’t understand doctors or what they are trying to tell them.
• In the confusion of the consulting process people find it difficult to concentrate on what the doctor is saying. Therefore, they may afterwards appear to be almost deliberately non-compliant.
• For reasons perhaps known only to them, people can withhold vital information from their doctor or simply not tell the truth. This may render the entire consultation worthless.
• There are some things that all of us may find impossible to talk about face to face with another human being. Sexuality may be one such subject.
Given all these natural fault lines that appear in many doctor-patient consultations, it occurred to me that the Internet might be the perfect medium through which to allow people augment and redress this often flawed process. Online medical consultation is not designed to and never will replace the traditional doctor patient physical interaction. It can however bring clarity and lend valuable support to this process. When a person commits to Online consultation they:

• Have the required time and space to concentrate on their complaints and symptoms.
• Are less inhibited about discussing difficult topics.
• Are not afraid to argue their point of view.
• Are less inclined towards untruthfulness.
• Have the time and space to absorb all that is being said to them.
• Can seek clarification until they fully understand their diagnosis and its implications.

Whether we like it or nor, and personally I know many doctors who don’t like it, people will use the Internet to try and diagnose and even treat their own illnesses. Or at the very least will go to their doctor pre-loaded with a lot of Google information and misinformation. The Internet has now irrevocably infiltrated the doctor-patient process. It is up to us in the profession to try and make this development as innocuous as possible.

For more information about Online Doctors and e-Consultations please visit:

Major Breakthrough in Treating Female Sexual Dysfunction

Major Breakthrough in Treating Female Sexual Dysfunction.

Testosterone for the Lady.

Dr Andrew Rynne.

People naturally associate the hormone testosterone, also called androgen, with men. It’s what makes us so nasty, so aggressive, so driven, so bald, so hairy and so sex mad. Isn’t that so? What very few people don’t realise though is that testosterone also plays a vital role in female sexual functioning. To be healthy, a woman needs to have androgen levels of approximately one tenth of that of young men. This they produce in their ovaries and adrenal glands. It plays a part in many things of which sex drive or libido is but one.

It may go against the grain to associate testosterone with femininity. After all, in the main when compared to men, women are gentler, better at empathising, more intuitive and more patient than men with their raging testosterone. So how could they possible need this stuff that enjoys such bad press? Recent studies have shown that post menopausal women not only lack oestrogen and progesterone but testosterone as well.

This low level of male hormone in post-menopausal women can give rise to many undesirable consequences. Indeed it is now suggested that testosterone may be the “missing link” in the management of menopausal symptoms not otherwise responding to standard HRT. To date this in the main consisted of oestrogen and progesterone. Included here are hot flushes, depression, osteoporosis and the sexual dysfunctions of vaginal dryness, dyspareunia, anorgasmia and low or no libido.

So how much testosterone replacement do ladies need? The quick answer is not a lot. At most her optimum levels of androgen will be from one seventh to one tenth of that of men. So, if a man requires on average 50mg of testosterone delivered daily via a gel call Testogel, then a woman’s requirement will be one tenth of this or 5mg of testosterone daily. A handy way to think of this is that if a man uses one tube of Testogel every day then the same tube of gel should last a woman one week. A little “toothpaste” sized smear on the inside of her forearm every day should do the job nicely.

Doctors who “approve” of testosterone replacement therapy for women are still thin on the ground and some of those like to try and make things complicated. Blood tests, for example, to measure the levels of testosterone that a post-menopausal woman might have, are largely a waste of time and money. They contribute not a jot to the diagnosis. Likewise, expensive specially compounded “female” testosterone replacement therapy will do a lot more for the doctor’s bank account than it will for client’s wellbeing. There is nothing wrong with existing pharmaceutically manufactured androgen gels as given to men.

It is in practise quite simple. All you need do is ask yourself some simple questions: Do you have post-menopausal symptoms not relieved with standard HRT? In particular, do you have sexual dysfunctions like vaginal dryness and loss of libido? If the answer to this is “yes” then try some testosterone replacement therapy at a does of about one tenth of that for a man? Did that improve things for you? If yes then continue if no then discontinue. Now, isn’t that nice and simple? Why complicate things?

To find out more about Testosterone treatments available for women please visit