Curved penis interferes with love life for student

Q: I am a 21-year-old college student with an embarrassing problem. I have dated some beautiful young women, but I avoid sexual intimacy because of my “curse.”

I suffer from Peyronie’s disease. My penis curves to the left when I am aroused. Is there anything that can be done to correct this problem?

A: We applaud you for seeking help for this condition. Many men suffer in silence.

Peyronie’s disease often occurs after some trauma to the penis. The resulting scar tissue can make the penis bend at an angle.

The Food and Drug Administration has approved a medication that contains collagenase, an enzyme that breaks down scar tissue. This injectable drug, Xiaflex, reduced penile curvature significantly more than placebo injections. If you decide to seek this treatment, be sure to consult a urologist who has experience utilizing it.

Xiaflex injections often are covered by insurance, but they are very expensive, running to thousands of dollars. Side effects may include bleeding, bruising, pain or itching. In a small number of cases, the injection itself injured the penis.

Other kinds of injections are not FDA-approved, but might be helpful. A specialist should be able to recommend the best treatment for you. Urologists treat some cases of Peyronie’s curvature with surgery.

Q: A couple of years ago, I was diagnosed with fibromyalgia. The rheumatologist questioned me about my sleep patterns and prescribed alprazolam at bedtime.

The result was dramatic. The fibromyalgia pain disappeared within a few days.

Aside from the pain, I am in excellent health at 75 years of age. However, I am concerned about my memory. Does alprazolam cause memory problems? Must I choose between pain relief and memory?

A: Sleep is critical for managing fibromyalgia. This mysterious condition produces pain in soft tissue, frequently associated with tender spots. Fatigue and trouble concentrating also are common symptoms.

Treatment with a benzodiazepine sedative such as alprazolam (Xanax) can pose problems, especially for older people. Such drugs may increase the risk of dementia (Expert Opinion on Drug Safety, May 2015). Alprazolam, along with other benzos, is on the list of potentially inappropriate medications for seniors. Our Guide to Drugs and Older People offers more information about such medicines. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. O-85, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www. peoplespharmacy.com.

There are no ideal treatments for fibromyalgia. Doctors prescribe drugs that affect brain chemistry such as pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella).

Nondrug approaches such as acupuncture or massage therapy may be helpful (Systematic Reviews, May 15, 2017). Practicing yoga or tai chi, a gentle movement program, also might ease fibromyalgia discomfort.