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 

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

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      

Buying Viagra and Calais and "sex" Drugs Online

Online Pharmacies are not legal in most civilized countries. There are 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.
o Most prescription medications need the input of a health care 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, stop smoking or talk to your lover about your erectile dysfunction.
o 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.
o 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.
o 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:
o Viagra is now the biggest selling online pharmaceutical in the world.
o Not all, or even most, erectile dysfunction requires Viagra to fix it.
o 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.
o 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.
o Much erectile dysfunction is not in fact fixt by using Viagra or Cialis. However, the self-medicating may not realize this and be inappropriately driven to depths of despair when these drugs fail to work. I see this all the time in my practice.
Normally I am all in favor 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. Erectile dysfunction is a classical case in point.

Dr Andrew Rynne

http://www.doctorrynne.com

Medical Specialist in Sexual Dysfunction. Ebook and online consultation for Erectile Dysfunction. Onlinedoctor consultation facility.

Curing Performance Anxiety

Performance Anxiety in the bedroom is a common and powerful blocker of enjoyment and can actually destroy an otherwise good relationship. Here I want to address Performance Anxiety (PA) as it effects men, or in other words PA as a leading cause of Erectile Dysfunction. Women too of course, can be effected where PA gives rise to a condition known as vaginismus. But I will talk about that another day.
PA as a leading cause of erectile dysfunction or impotence can literally happen overnight. All it takes for PA to give rise to a lifetime of erectile dysfunction is just one single mishap. It could have been too much to drink, or maybe just a throwaway comment about your size or preparedness for intercourse, or perhaps it was a new relationship that you were worried about, the smallest thing can give rise to a single "failure" leaving a man wondering about his potency forever thereafter.
Do you see, for an erection to develop there must be no distractions whatsoever. What is required is pleasure, desire, arousal and excitement. With these emotions running high the blood supply to the penis increased and the man has an erection. It's like magic. Questions in the mind like is it hard enough, is it long enough, will I put it in now - any little niggling doubts at all will kill off the magic and erection process stone dead in the water.
And, another thing to remember. It is not your fault that this is happening and it is not her fault that its happening and it is very important that that be made clear and that you discuss it between yourselves. There is no room here for any blame games. Once negative thoughts begin to invade the bedroom it is extremely difficult to banish them. The thing can become a self-fulfilling prophecy and a vicious circle all rolled into one.
So what is the remedy doc? Today we are lucky -- we have two choices. Twelve years ago, we had only one. Which you choose depends on your circumstances. It does not necessarily have to be one or the other either, a little of both can also be very effective. Remedy number one is predominately for couples in a stable relationship and remedy number two is predominately for men not in a steady relationship.
Number one: Stop performing. If you, the man, are not expected to perform then you cannot have performance anxiety. This may take a week or two of practice of course but you the woman do all the pleasuring creating an erection and allowing it to die down until you are eventually confident enough with this. Now kneel over your partner, one knee on each side and place his penis in you vagina. Over the next few weeks move along from there. A sense of humour might also help.
Number two: Ask your doctor for a prescription for tadalafil 20mg. Take one a day for a few days. Then take on only on day you expect to be having intercourse. These should give you PA resistant erections and return your confidence such that you will not need to take them all the time. Please visit my website for more information and help.

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.

Proven Tips to Cure Your Erectile Dysfunction

Proven Tips to Cure Your Erectile Dysfunction

The First Tip: Do not panic and jump at the first quick fix on offer.
When you first experienced erectile dysfunction your initial reaction may well have been one of great alarm, great concern and near panic. This initial reaction is understandable of course but unfortunately, it may also be disabling. Fear and alarm may already have driven you into the Internet to try to find a ready solution. These are shark-infested waters at the best of times, nowhere however is this better exemplified than in the area of so-called "natural" cures for erectile dysfunction. These, usually herbal, readies have three major drawbacks:
• Totally unqualified individuals are offering them for sale on the internet.
• They do not work, or at best only work partially.
• No attempt is being made at diagnosing the cause of your particular erectile dysfunction. One size is supposed to fit all.
So, if you have already been down this road of false promises and can vouch for the validity of what I am saying here, then do not worry, thousands have been there before you. It is now however time to make a fresh start.
The Second Tip: Make some life style changes for a start.
If you smoke or drink alcohol heavily, consider quitting. If you live a sedentary existence and take no exercise, consider a training program to loose a little weight and get a bit fitter. If you are in a stressful job or personal relationship is there anything, you can do to alleviate those tensions like changing your job or ending your relationship.
The Third Tip: Discuss your problem with a specialist.
You will need to diagnose the underlying cause of your problem. This is essential. Erectile dysfunction is not a condition that lends itself to self-medication and self-treatment. It is not like having a head cold or something where you can just pick something up at your corner store and expect that you will get better. This is an area where you are going to need professional guidance. This should come from, not just any old doctor or councillor, but from a therapist who specialises in the treatment of erectile dysfunction.
Fourth and Final Tip: There are two important things that you should know about erectile dysfunction today and they are both good news:
(1) Over 35% of all erectile dysfunction, from whatever cause or occurring in whatever age group resolves itself over time without any treatment.
(2) ALL erectile dysfunction, regardless of cause, severity or age of onset, is treatable and manageable today without having to resort to vacuum pumps or surgical prosthesis. There never has been so many modules of treatment and with very little effort and a bit of help from me, you can find the one that best suited your particular needs today.
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.