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 

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

Why Buying Erectile Dysfunction Medication Online Is A Bad Idea.

Why Buying Erectile Dysfunction Medication Online Is A Bad Idea.

Online Pharmacies are not legal in most civilised countries. There are some very good reasons why this is so and it is not just a case of "control" or of big brother keeping an eye on you. Here are just a few reasons why online pharmacies in general can be bad for your health. I will return specifically to Viagra later.
* Most prescription medications need the input of a healthcare profession if they are not to be abused. Often, simple lifestyle changes can render the use of medications obsolete. However, lifestyle change requires human effort. It is so much easier to buy online than it is for example to loose weight, take more exercise or stop smoking.
* Prescription medications need to be taken in the proper dose and in a prescribed manner. Otherwise, they are open to abuse and can be damaging or addictive. Sleeping tablets are a good example of harmful medication when not controlled. Online Pharmacies offer no such control.
* Online pharmacies are uncontrolled and uncontrollable. Therefore no assurances can be given that product is in fact what it says it is on the package. Generic or worse still, totally fake tablets or capsules can be dispensed. You simply have no way of knowing what is or is not what you hope it is.
* But even more worrying than this is the possibility of lethal contamination. There are on record cases of where active ingredient or excipients have, wittingly or unwittingly, found their way into spurious pharmaceutical products with fatal consequences.
These serious reservations apply to all medications purchased from Online Pharmacies. However, in the case of Viagra and other erectile dysfunction treatments, there are additional pitfall and dangers that are particularly worrying. I can only touch on a few of these here but this should give you an idea:
* Viagra is now the biggest selling online pharmaceutical in the world.
* Not all, or even most, erectile dysfunction requires Viagra to fix it.
* Viagra is now widely used as a 'recreational drug' in the mistaken belief that it improves erections where no dysfunction exists. If it were not for internet selling this situation would not have evolved.
* Taken in this way Viagra can actually CAUSE erectile dysfunction by allowing for a 'performance anxiety' situation to develop. Performance anxiety is the commonest cause of erectile dysfunction that there is.
* Much erectile dysfunction is not in fact fixt by using Viagra or Cialis. However, the self-medicating may not realise this and be inappropriately driven to depths of despair when these drugs fail to work. I see this all the time in my practise.
 
Normally I am all in favour of patient's autonomy and of people taking charge of their own illnesses. I am not in principle opposed to sensible self-medicating and self-care. People cannot go running to their doctor or drugstore with every little sniffle and sneeze. Indeed, I once argued for the free availability of the "morning after" pill as a means of reducing abortion demand. But Online Pharmacies? I think not and I hope that after reading this you might agree with me.
 
Dr Andrew Rynne.
www.doctorrynne.com

Persistent Sexual Arousal Syndrome (PSAS) or Persistent Genital Arousal Disorder (PGAD).

Persistent Sexual Arousal Syndrome (PSAS) or Persistent Genital Arousal Disorder (PGAD).

Persistent Sexual Arousal Syndrome or (more recently) Persistent Genital Arousal Disorder is a condition that effects women usually in their 40’s and post-menopausal years. It may be defined as persistent, intrusive and unwelcomed sexual arousal in women that differs qualitatively from that associated with sexual desire and that is not relieved by masturbation or orgasm. It is invariably described as a “rare” condition although it is readily acknowledged that, for obvious reasons, it may be under reported most particularly in underdeveloped countries.

Persistent Sexual Arousal Syndrome is not, contrary to popular belief, a trivial or humorous condition. People, including other women, may think that a permanent state of sexual arousal would be a desirable or even an enviable thing. But this is to completely misunderstand the intrusive and relentless nature of the arousal and how it differs from that associated with voluntary sexual activity. It may also be to confuse this condition with hyper sexuality or so-called nymphomania. Indeed, so distressing can this syndrome become that sufferers often report suicidal ideation.

When it comes to finding any cause for this distressing condition researchers remain very much in the dark. However, it is interesting to note yet again that, even here, our old friends the antidepressants may be implicated. Both the tricyclic and the SSRI group of drugs have been associated with PSAS. In the case of the former Trazodone in particular has been implicated. In the case of the latter it should be noted that simply discontinuing the drug give no assurance that the PSAS will quickly abate at abate at all. The ill-effects of drugs that interfere with neurotransmitters like serotonin can be life long.

If identifying a cause of PSAS is difficult so too of course is finding a solution to the problem. In our present state of knowledge no definitive treatments have been identified that give consistent results. The situation is changing and research is on going.

A useful place to liaise with fellow suffers might be to register on:  http://www.psas-support.com

This is where a cure, when one is eventually found, will be first posted.   

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

The Dark Side of Testosterone Replacement Therapy (TRT)

The medical profession remains split on the question of Testosterone Replacement Therapy (TRT) and its value for older men. Those who are opposed to it in principle, as it were, will argue that TRT is dangerous and unnecessary and that low levels of circulating testosterone in older men is natural and should not be interfered with. That at least is what they will say in public. In private, anti TRT doctors will express serious reservations about increasing older men's libido and reduction their erectile dysfunction.
In fact, it is this very misconception --- that TRT is to do solely with older men's sexuality that may be subliminally militating against the broader uptake of this otherwise useful therapy. I say that this is a misconception because in my experience of treating older using TRT, increased libido or sex drive and reduction of erectile dysfunction are far from the predominant effects of testosterone replacement. This does occur of course but it is subtle and not at all pronounced.
Doctors who are opposed in principle to HRT for older men seem to ignore, or be unaware, of other potential benefits to this treatment that have nothing to do with a man's sexuality. Recent studies have shown that nasty, age related conditions like Alzheimer's, dementia, type 2 diabetes, osteoporosis, cardiovascular disease and the Metabolic Syndrome may all be positively effected by testosterone therapy.
For example, a recent article published in the Journal of Andrology (Vol. 30 No 5 Sep/Oct 2009) makes for very interesting reading indeed. This is the work of four highly respected scientists: Abdulmaged Traish, Farid Saad, Robert Feeley and Andre Guay. In a broad met analysis of all the work carried out into testosterone replacement therapy over the last ten years, these investigators concluded: "Androgen Deficiency (low testosterone) might be the underlying cause for a variety of common clinical conditions such as diabetes, ED, the Metabolic Syndrome and cardiovascular disease."

If this subject interests you, I recommend you read this paper it its entirety. It is available here at this article.
If you have any questions at all that you think I might be able to help you with, I am available through me website here at 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.

Finding a cure for my Erectile Dysfunction

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.

A Broken Penis – it can happen.

A Broken Penis – it can happen.

This morning I had a young man from Toronto on to me. I’ll call him Tony for now. Toney’s story was particularly tragic. What made it all the more so was the feeling that I could not do much to help him. Aged 36 now he related the story of how he had been in an abusive marriage up to eight years ago when he became divorced. Towards the end of this traumatic period of his life Tony became so frustrated and angry that once, while masturbating, he made some particularly violent movement with his erect penis. I will let him take up the story here:

“While masturbating I made a sudden sideward’s manoeuvre with my erect penis. I can’t really remember the exact details of what happened but whatever it was, I do remember hearing and feeling something snap deep within my penis back towards my testicles. There was sudden pain and my erection disappeared before I ejaculated. Ever since then the quality of my erections are very poor”

Now, when I heard this story, perhaps because I have heard similar ones before, it immediately occurred to me that Tony was in some considerable trouble. He said he heard and felt something snap within his penis. His erection disappeared and he felt pain. To me immediately this could only mean one thing. Tony had damaged or broken a structure within his penis called the “tunica Albuginea”. This is the strong membrane that lines the chambers that holds the blood in the penis to give an erection. It is a strong membrane but it is not impervious to injury.

That was eight years ago. At the time of the accident Tony did nothing about it. This of course is all too understandable. He was embarrassed and angry. Some weeks later, mainly because his erections did not return and he was worried Tony went to his GP, told him his story and was, correctly in my view, referred to an urologist. But this is where his luck really ran out altogether. The urologist that Tony consulted opined that his erectile dysfunction was “all in his head” and offered no further advice.

Years rolled by during which Tony was having considerable difficulty getting any erections at all and during which he consulted a further two urologists. Amazingly, they both held the same erroneous opinion that his problem was all “psychological”. It beggars belief that two consultants, on hearing this man’s story of something “snapping” within his penis, did not twig the diagnosis or take any measures to diagnose a fractured penis properly.

It was not until yesterday, through Internet consultation with me that Tony, for the first time in eight years finally heard the true story of what happened all those years ago. I am telling this story, not to show how clever I am because in truth the diagnosis should have been obvious to any doctor. I’m telling it as a very salutary tale and a warning and it is this: If you hear something snap within your penis, or your partner thinks he hears something snap within his penis while up to some sexual high jinks, then please treat this immediately as an emergency. Treated in time a fractured penis can be repaired. Left for a few hours and it may be too late.