Mortifying reason he can’t make love
MY HUSBAND has suffered from Peyronie’s disease for the past year. He is still waiting for a hospital appointment. He was given potassium powders and he had an adverse reaction. He can’t make love any more. Can you advise?
Names and address withheld.
This is a seriously distressing disorder, and it must be a burden for you both. Peyronie’s disease is where fibrous scar tissue f orms i n the penis, causing curved and painful erections as well as thickened nodules (called plaques) in the shaft.
We don’t know exactly why it occurs, but 20 per cent of patients will also have Dupuytren’s contracture, a condition where the fingers on one or both hands become bent towards the palm.
And for 2 per cent of patients there is a family history of Peyronie’s. This suggests there is a genetic link, but repeated minor injuries (even if you’re not aware of t hem happening) may also play a part, as the disorder is thought to be linked to an abnormality in the woundhealing process.
About 5 per cent of men are said to be affected, but this figure may be an under-estimate, as some may be too embarrassed to talk about it or, because i t tends to occur with age, they accept it as part of getting older.
The condition resolves without treatment in about 12 per cent of patients, but in about half of cases the deformity worsens (although the pain on erection usually gets better within a year or two of the disorder developing).
Research into medical treatments has been limited. One option is the ‘potassium powders’ your husband has been prescribed — potassium para-amino benzoate (brand name Potaba) comes as capsules, tablets or in sachets.
it is an anti-fibrotic drug, but the evidence for its effectiveness is vague. Moreover, it is expensive and commonly leads to gastrointestinal sideeffects, such as abdominal pain.
There are those who swear by vitamin E pills. This is a potent antioxidant when taken by mouth and it is believed to affect scar formation, but studies do not show benefit in Peyronie’s disease.
OThER oral medications include colchicine (usually used for gout) Tamoxifen (a breast cancer drug), and pentoxifylline ( usually used to improve blood flow in patients with circulation problems), but again studies are unclear about how well they work.
The nodules can be treated with injections of verapamil, interferon alpha 2b or collagenase, which work in different ways. These treatments are generally safe, and when administered with skill and local anaesthetic have shown improvement in some patients. however, if the problem has persisted for more than 12 months and the deformity is interfering with sexual function, as in your husband’s case, then surgical treatment is advisable.
There is no one single recommended procedure, and the specialist will make a decision based on the individual circumstances. One option is plication — surgery to shorten a section of the tunica albuginea (the tough layer of connective tissue in the penis affected by Peyronie’s).
Alternatively, the surgeon may lengthen a different part of the tunica albuginea, usually by grafting in a section of a vein, taken from elsewhere in the body.
The best prospect for your husband is the forthcoming referral to the urologist — the important thing is to let the specialist decide on the best technique. I HAVE acid reflux and have been told that the valve at the point where the oesophagus joins the stomach does not close. I have been taking ranitidine and omeprazole but still get the reflux, and have resorted to taking antacid solutions. Is there anything that can be done? I am 62. Sylvester B. Chileshe,
Chingola, Zambia. AciD reflux, also known as gastrooesophageal reflux, occurs when the contents of the stomach spill back upwards into the oesophagus (or gullet). This happens to all of us from time to time. it is only considered a disease when it causes regular symptoms, which may include heart burn—a discomfort in the chest that sometimes spreads to the throat — or difficulty swallowing, hoarseness, sore throat or cough.
Frequent acid reflux can cause damage to the oesophagus; this can include bleeding ulcers, stricture ( narrowing of the oesophagus due to scarring), and Barrett’s oesophagus (changes in the cells lining the lower oesophagus, which can become cancerous in future). it can also cause lung and throat problems.
All of these complications occur because, unlike the lining of the stomach, which actually secretes the acid, the oesophagus does not tolerate it well.
Most cases of chronic acid reflux are thought to be caused by a problem with the lower oesophageal sphincter. This is a ring of muscle where the oesophagus joins the stomach.
it works like a valve; after you swallow, it relaxes to allow food to pass through, then contracts to prevent spillage back upwards. in some people, this function fails or does not work properly.
some patients may also have a hiatus hernia, where part of the stomach squeezes up into the chest through an opening in the diaphragm, the horizontal wall of muscle that separates the abdomen from the chest.
A hiatus hernia can prevent the valve at the bottom of the oesophagus from functioning properly, making acid reflux more likely.
You say that you are still experiencing re flux despite medication. My question is whether you have symptoms — such as pain or cough — or whether you are merely aware of the regurgitation at times. The severity of your symptoms could influence the course of action you take.
The medication you are taking, ranitidine and omeprazole (which reduce the amount of acid the stomach produces) will not affect the mechanics of acid reflux, and if you still have significant discomfort you may benefit from some other measures.
First, losing weight can help. in addition, raise the head of your bed by about 6in — this allows gravity to assist in keeping the stomach contents from spilling into the oesophagus.
AvOiD smoking and avoid eating for at least three hours before bedtime. Or if you do eat, have only a small meal and go for 30-minute walk afterwards.
There is no evidence that antiacid liquids improve reflux, though they may reduce the discomfort of persistent heartburn: they work by coating the lining of the oesophagus to protect it, as well as blanketing the stomach contents to prevent the acid refluxing upwards.
surgery is an option for severe cases. The most common procedure, laparoscopic Nissen fundoplication, involves wrapping the upper part of the stomach around the lower end of the oesophagus, effectively creating a new valve.
The results are good, though complications can occur and the repair may, in time, fail. Don’t push for this operation merely to deal with a sense of regurgitation — we all experience regurgitation at times, and it is better to tolerate that than undergo the hazards of general anaesthesia and surgery, which should never be underestimated.
My view is that surgery should be reserved f or those who have persistent and severe symptoms, despite taking medication and after the lifestyle changes outlined.