Tuesday, March 22, 2011

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 22nd 2011

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

Monday, March 7, 2011

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.

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

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.

Sunday, March 6, 2011

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