Wrong Diagnosis

Shoehorning the Wrong Diagnosis.

Please don’t get me wrong. I have nothing against self-diagnosis and self-help when it comes to your health. Nor am I saying for one second that doctor knows best and patients should do what they are told to do by their doctor. On the contrary, I am all in favour of assertiveness in the doctor’s consulting room, all in favour of asking loads of questions and keeping the medics on their toes. As one myself I can assure you that doctors do NOT always know best or even know at all.

There are however exceptions to this rule, there are times to perhaps acknowledge that the old docs might actually know what they are talking about sometimes. A good example of this is in the management of erectile dysfunction in young men. There is something very peculiar about this common malady whereby the sufferer seems to want to hear certain explanations for his ED and reject treatment suggestions that somehow don’t seem to suite his predetermined prejudices. Nobody wants to be told that they have performance anxiety for example.

Take Jake  from Saigon as a case in point. Jake, aged 36 came to me through my online medical consulting service. His complaint was erectile dysfunction his story typical yet quite extraordinary. Three years ago Jake bought some diet pills on the Internet and proceeded to take one a day. Of course this was foolish but if he had only left it at that it may not have been too bad. Worse was to come, much worse.

After taking these diet pills for a few days Jake noted, somewhat to his dismay, that he could no longer sustain an erection for more than a few minutes. Alarmed he went straight to his doctor and told him that diet pills had given him ED. Of course we don’t if the diet pills were in fact the cause of his ED but in Jake’s head that was the case and that was that. The doctor certainly did not agree that the diet pills had anything to do with it and offered Jake some Viagra to get him going again. Jake totally rejected this suggestion and, very annoyed he decided to consult Dr B and then Dr C. When Dr C also suggested Viagra Jake decided to see a specialist, an endocrinologist. Time to wheel in the Experts says Jake to himself.

At this stage Jake was beginning to think that maybe it was not the diet pills after all that were causing his ED and maybe the problem was a low testosterone. Armed with this new inspiration he asked the endocrinologist to run some hormone assays on him and low and behold didn’t the testosterone levels come back as “low”. Jake was at last vindicated. He knew what the problem was all along. The endocrinologist immediately ordered some Testosterone Replacement Therapy and everyone sat back and waited for Jake’s erections to return to their former magnificence.

Days ran into weeks and weeks ran into months and still the old erections would not last long enough to complete intercourse or to bring Jake’s long suffering wife to orgasm. Things were becoming desperate indeed. It was at this point that Jake was visited by yet another piece of inspiration. If his ED was not being caused by diet pills or a low testosterone level then the problem had to be a venous leek. There was something intrinsically wrong with Jake’s penis such that it would not hold the blood to sustain an erection. That had to be it. Time to see a surgeon says Jake to himself.

The Urologist obligingly went along with Jake’s suggestion of a venous leek and performed what’s called a Doppler test on his penis. And guess what? Yes you have got it, Jake was right again; he did have a venous leek! Surgery was organised to fix this defect, three month later and no improvement and Jake, at this stage a bit desperate it has to be admitted, was online availing of my $19.00. online consultation services. He presented himself as a victim of a series of stupid doctors who collectively could not fix his ED. He said very little about his not accepting the first doctor’s suggestion that his problem was performance anxiety erectile dysfunction. Nor did he acknowledge that the low testosterone theory and the venous leek theory were Jake’s inspiration and not the doctor’s.

If there is a there is a salutary lesson to be learned from this sad saga it is this: Common things are common and the commonest cause of erectile dysfunction in young is not diet pills, nor is it low testosterone levels, nor is it venous leek. No, the commonest cause of erectile difficulty in young men is performance anxiety and while that may be a bit pedestrian and lacking the exotic it is non-the-less true and very easy to fix. Jake would have done well to have listened to the first doctor he went. He could have saved himself a lot of pain.

What do you think? Please leave a comment. 

Dr Andrew Rynne. http://www.doctorrynne.com 

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.

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.

www.doctorrynne.com

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.

http://www.doctorrynne.com

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  www.doctorrynne.com

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.

Summary.

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: http://www.doctorrynne.com/

Benign Prostatic Hyperplasia

Benign Prostatic  Hyperplasia – the Classical Design Fault.

Lets face it, these days very very few patients indeed will consult their doctor without having first consulted Google, Yahoo, Bing and Wikipedia. Love it or hate it (and I suspect most of us are not overjoyed at the prospects of competing with computers) it is now the way of the modern world. It is here and here to stay.

Benign Prostatic Hyperplasia or sometimes, incorrectly, hypertrophy, is of course your classic. It has become a Global industry that stuffs the search engines for thousands of pages. Doctors, surgeons, hospitals, clinics, pharmaceutical and alternative enthusiasts all feed greedily from the bottomless trough that BPH has become. Any wonder then that the middle aged man, finally deciding to consult a real doctor for his dysuria, comes laden down with tonnes of cyber babble and internet rubbish.

The textbooks, but now of course the search engines; tell us that the incidence of BPH is about 50% in men over the age of 50 and more or less leave it at that. Doctors know of course that that is not the full story. In real life we know that the incidence of this pestilence increases with age such that by the age of 80 well over 80% of men will be significantly effected by it. Indeed all men will eventually fall foul to this design fault of nature. For that is what it is – a classical design fault. The urethra should never have been made to pass through a gland that is destined to enlarge with age. All men should  be recalled at the age of forty and have this put right!   

False dawns, in the form of “office procedures” for the surgical management of BPH continue to come and go. Transurethral Microwave Thermotherapy machines, like Electronic Voting machines, now lie gathering dust in back storeroom of many the teaching hospital. They are embarrassing monuments to the folly of rushing into unproven new technologies. Not only did they not work, they were also quite dangerous. Laser Turps, one suspects, may very well be heading in the same general direction. I will leave to others to inform us about its true efficacy when the dust eventually settles on this still controversial treatment.

If recently introduced minor surgical interventions for the management of BPH have been more gimmicks that genuine then the same can hardly be said about the pharmaceuticals. I refer particularly the alpha blockers of course. In the last twenty years, these medicines have allowed millions of middle aged men across the world, to get on with their lives in relative comfort and without the constant fear of the nightmare that acute urinary retention must be. They have also allowed men to at least postpone, perhaps indefinitely, the indignity in a TURPS procedure with its attending morbidities. Clearly I’m a big fan of the alpha blockers.

Not so however 5-alpha reductase inhibitor. Because Fenasteride has the ability to reduce prostate bulk by some 25% and so relieve some of the symptoms of BPH, this drug is now being pushed as a first line treatment for this benign condition. I believe that this is akin to the old proverbial sledge hammer approach to cracking a nut and I’ll tell you why.

Over the last five years or so, for my sins, I seem to have become more and more involved in the management of sexual dysfunction, not just erectile dysfunction but all sexual dysfunction in man and women. On the internet, hardly a week goes by that I am not being approached by yet another young man recently prescribed Propecia as a “treatment” for male pattern baldness. This drug has the capacity to obliterate their sexuality, not just for the time that they take the drug, but for all time. This vanity treatment can and does condemn many young men to a life sentence of sexual anhedonia, without feeling, desire or function, to otter misery and despair for which, as yet, we have no treatment. If you would like to know more about this you can share in their pain on www.propeciahelp.com

I believe that potentially toxic medicine like this must be reserved for the indications for which it was first introduced and that is in the management of advanced prostate cancer with metastases. Here, as we all know, it can be life-saving or at any rate life-prolonging. Using it to treat a benign condition like BPH is, in my view, at best questionable. Using it to treat a naturally occurring condition in men like male pattern baldness, is reckless in the extreme.

Finally, a word on tadalafil, the longer acting treatment for erectile dysfunction. Can I refer you to the October issue of the Journal of Urology 2008? Here is reported a study that found tadalafil to be as effective as the alpha blockers in relieving Lower Urinary Tract Symptoms of BPH. Since older men often suffer from both BPH and erectile dysfunction and since tadalafil has been clinically shown to relieve both, might not an argument be made for prescribing daily tadalafil for such men. Two birds with one stone perhaps? I think so.     

Dr Andrew Rynne.

March 22^nd 2011

Doctor Rynne is an expert on male and female sexual dysfunction. For more information please visit http://www.doctorrynne.com.

Find the Right Consultant to Fix My Erectile Dysfunction

Erectile Dysfunction Treatment

You have a number of choices but they can be broadly divided into two categories of professionals:
(1) Clinical Psychologists
(2) Medical Doctors
(1) Clinical Psychologists. Clinical Psychologists are professional graduates specifically trained to talk, to listen, and to guide people suffering from a wide range of emotional and mental upset. As a rule, they offer an excellent drug-free alternative to Psychiatrics.
If you choose to consult with a Clinical Psychologist about your sexual dysfunction make sure it is one who has a specialist interest in this subject as distinct from a General Clinical Psychologist. Generalist might treat anything from aerophobia to insomnia and, while they may be excellent at their job, they may lack the subtle skills that can make all the difference when it comes to resolving your erectile dysfunction.
Be weary also of posers and charlatans operating in this area. There are hundreds of unqualified people out there offering a quick fix for erectile dysfunction through hypnotherapy or herbal remedy. Always ask about qualifications and for any scientific studies supporting their claims. If either of these seem lacking or are being obfuscated, then steer clear.
If you choose a Clinical Psychologist to help you overcome your ED then ensure that they are fully qualified, that they have many years experience, that they specialise in managing sexual dysfunctions and that they are working from an accredited professional setting such as a University based Department or Family Planning Clinic. Never be afraid to ask questions. It is your right to know exactly who to going to try and help you through this difficult and sensitive problem.
Just one final word about Clinical Psychologists treating sexual dysfunction: Whereas they undoubtedly have a great deal to offer, they are nonetheless confined to treating your erectile dysfunction without the benefit of any prescription medicine. This, in some respects, maybe admirable but some cases of erectile dysfunction simply cannot be resolved without at least some medication. You do need to bear this in mind if choosing a Clinical Psychologist.
(2) Medical Doctors. The same rules apply to Medial Doctors. If you are choosing a medical doctor to help you to resolve your erectile dysfunction then make sure that he or she has many years experience and has a specialist interest in treating sexual dysfunction. Here is a useful tip for you. Ask yourself these questions about the doctor treating your erectile dysfunction:
(a) Is the doctor treating my erectile dysfunction genuinely trying to understand my problem and diagnose the underlying cause? If the answer to this is ‘no’ then you may be with the wrong doctor.
(b) Is the doctor treating my ED a generalist or a specialist? If the doctor is a generalist treating all diseases then perhaps you are in the wrong place.
(c) Is the doctor dealing with my erectile problem prepared to stay with me until a solution is found, or simply throwing Viagra at the problem and hoping for the best? If the doctor seems willing to give up on you after trying a few tablets then you should definitely take your problem elsewhere.
(d) Is the doctor treating my erectile dysfunction well known as a specialist in managing this problem? If the answer to this is ‘no’ then maybe you should be looking elsewhere.

SUMMARY
In finding a professional to help you overcome your erectile dysfunction, you may choose either a Clinical Psychologist or a Medial Doctor.
If you decide to consult a Clinical Psychologist then:
(a) Ensure that they specialise in treating sexual dysfunctions and are not just a general Clinical Psychologist.
(b) Ensure that they practise from a credible setting.
(c) Remember that they will not be in a position to prescribe any mediation.
(d) Realise that, while they may be excellent at treating ED related to anxiety, this maybe the totality of their skills.
(e) Understand that a Clinical Psychologist may be very limited as to their diagnostic abilities.
If you decide to consult a Medical Doctor then:
(a) Make sure you are talking to a specialist in treating sexual dysfunction, not just to a General Practitioner dabbling in this area.
(b) Ask yourself is the doctor genuinely trying to diagnose the underlying cause of your problem.
(c) Enquire if the physician can offer the whole range of ED treatments including Testosterone Replacement Therapy and painless penis injection where appropriate.
(d) Ensure that the doctor is prepared to stay working on your problem until a solution is found that you find satisfactory.

Dr Andrew Rynne
http://www.doctorrynne.com

Dr Andrew Rynne is a medical practitioner and writer. He has thirty years experience in treating Sexual Dysfunction but most particularly Erectile Dysfunction and Premature Ejaculation.

Anorgasmia, Causes and Treatment

Anorgasmia - For Women who cannot Orgasm through intercourse.

It is estimated that as many as one in four women suffer from this sexual difficulty. Not being able to orgasm during intercourse can put a real strain on your daily life, as well as your sex life. Before too long your inability can spiral into a major problem that you feel you'll never find a cure for. It can make a woman feel utterly inadequate and miserable. Her sex partner also will often incorrectly blame himself and this can make matters even worse.

 

Like so many sexual dysfunctions, Anorgasmia often elicits very little understanding and even less sympathy. So what if you can't have an orgasm during intercourse? Therefore it must it is very easy to feel that no one fully understands what you are going through, or is prepared to take your problem seriously. Searching for a quick fix it is likely that you will have considered the many pills, exercises and devices available both online, and in some cases, as a prescription via your GP.

Anorgasmia is defined as the sustained inability to reach orgasm through sexual intercourse while not having any trouble when alone through masturbation. It is a complex multifaceted problem involving all aspects of a relationship both physical and emotional. In may be caused by something as simple as depression or stress or a lack of physical fitness. Or it can be caused by something more complex like premature ejaculation in the man, distrust, anger or inadequate sexual stimulation.

Lack of communication and faking orgasms are other major issues often found in conjunction with Anorgasmia. Women may find it easier to lie and to pretend to have had an orgasm rather than run the risk of hurting his fragile ego or of having him, perhaps unfairly, blame himself. A history of sexual abuse or exploitation or one of a repressive upbringing are other areas that need enquiring into.

Finding that solution, tailor-made to address your specific needs, can be a challenge. Too many people think that by just throwing tablets at it, female Anorgasmia can be cured. If you are already taking SSRI antidepressants then these need to be discontinued before any progress can be made.

 

Dr Andrew Rynne.

http://www.doctorrynne.com

 

Dr Andrew Rynne is a medical practitioner and writer. He has thirty years experience in treating Sexual Dysfunction in men and women.