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: www.doctorrynne.com

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 www.doctorrynne.com

Testosterone Replacement Therapy – What You Need to Know

Testosterone Replacement Therapy – What You Need to Know.

Dr Andrew Rynne.

The news emerging about Testosterone Replacement Therapy (TRT) keeps getting better all the time. Recent published clinical trials show benefit for this treatment far beyond boosting libido or reducing erectile dysfunction. It is now becoming apparent that TRT has the potential to not only prolong life but to also improve the quality of that prolonged life. In addition to this exciting news, criteria for deciding who might benefit from this treatment have been greatly simplified. And yet, for reasons that I will try and explain later, most doctors remain opposed to this potentially life saving treatment.

It has now been shown unequivocally that by raising testosterone levels in your blood you can:

Ø Reduce insulin requirements in people suffering from type 2 diabetes.

Ø Reduce blood lipid levels and thus the need to take medications for this purpose.

Ø Improve coronary artery disease and its symptoms of angina pectoris.

Ø TRT also reduces visceral fat or “pot belly” so common in older men.

Ø Cognitive function or brain power is improved by keeping testosterone levels up.

Up to a few years ago, it was common practise for those seeking testosterone replacement therapy that they be required to undergo a range of expensive and not altogether reliable hormonal assays. Recently it has emerged that not only were these tests not necessary but also that they added nothing to the decision making process as to whether one might benefit from TRT or not. Today, most enlightened doctors, rely on presenting symptoms and complaints, not on blood tests, when making this decision.

In spite of all these clinically proven advantages for taking TRT must doctors remain opposed to it today. This is due to their harbouring deeply ingrained erroneous notions about raised testosterone levels and the incidence of prostate cancer. Metastatic prostate cancer may be temporarily checked by reducing testosterone levels to zero. This however does not mean that the corollary is true, that raised testosterone increase the incidence of prostate cancer. Clinical studies designed to show this to be the case have all failed to do so. Prostate cancer is a disease of older men with declining testosterone levels and to suggest that raised levels could in any way increase prostate disease is to fly in the face of reason and science.

I believe that as time goes on TRT will eventually become mainstream treatment for some men troubled by their ageing process.  In the meantime, if you would like to know more about this exciting subject, then please visit my website and ask me any questions that you might have. It would be my privilege to try and help you. Thank you for your interest.

Find out more about Testosterone Replacement Therapy at www.doctorrynne.com

My Doctor Will Not Give me Testosterone Replacement. Why?

My Doctor Will Not Give me Testosterone Replacement. Why?
Dr Andrew Rynne.

Doctors around the world still remain sceptical about the value of testosterone replacement therapy (TRT) for certain men. They remain very sceptical against a backdrop of ever mounting good peer review clinical evidence showing that TRT has the capacity to greatly improve older men’s quality of life and indeed maybe even extend their life expectancy.
These doctor’s objections to TRT for older men may spring more from their emotions rather than from their intellect. Here are just some or their erroneous arguments and why I think they are wrong.
(1) The Women’s Health Initiative  Study, published in 2002, showed that HRT was dangerous. This is a felonious argument on several fronts. First of all what this study actually showed was that Progesterone/Oestrogen combination increased the incidence of breast cancer in women by eight cases per annum per ten thousand women so treated.  Secondly, it is nonsense to extrapolate from that which might be true for women in HRT to men taking Testosterone Replacement. At best that’s emotional, not scientific.
(2) Falling levels of testosterone is part of the ageing process and its consequences are natural. Here is another classic for you. Osteoarthritis of the hip is also part of the ageing process and its consequences are natural. But is anyone seriously suggesting that we should not treat osteo of the hip?
(3) Testosterone Replacement Therapy might raise the incidence of prostate cancer. First of all there is not a shred of clinical evidence that this is the case. And secondly, cancer of the prostate is NOT a disease of younger men with high levels of testosterone. It is a disease of older men with low levels of testosterone. If anything then, testosterone might be protective against prostate cancer but I am not making that point here.
(4) Testosterone might fan the flames of an existing, yet to be detected, prostate cancer. This fallacy comes from confused thinking. Because by removing all testosterone you can bring about a temporary remission in prostate cancer, therefore by adding testosterone you might make matters worse. This type of logic, if even logical it is, is called a corollary. Corollaries may work like a dream in religion or philosophy but have no place in science or in clinical medicine.
Doctors waffling on about the “dangers” of TRT are forever preaching to the rest of us about Peer Review and Evidence Based Medicine.  They usually do this from the high moral ground of academia. And yet when it comes to ignoring their own advice, they seem to show very few qualms indeed.
This might be funny if it were not also quite tragic. We now know that TRT has many potential life enhancing and indeed life giving properties. The evidence for its value it treating the metabolic syndrome is emerging every day in new clinical trials. And yet so many of my colleagues are still with the dinosaurs.   

Doctor Andrew Rynne www.doctorrynne.com

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

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.