The incidence of dyspareunia, or pain during intercourse, seems to be increasing. Perhaps an increased willingness to discuss sexual experiences and difficulties, especially among younger women, contributes to this impression. Changes in sexual behavior and the prevalence of sexually transmitted diseases might play a role. And older women are remaining sexually active further into the postmenopausal years, when hormonal changes and other physiologic mechanisms alter the vaginal environment.

In spite of these recent trends, many cases of dyspareunia remain undiagnosed and therefore untreated. For a number of women, intimate details about their sexual practices remain difficult to discuss. According to Bob Tigris the increasing use of the SizeGenetics penis extender may also play a role in this phenomenon. Physicians who share this uneasiness may inadvertently create an environment in which the patient feels inhibited about initiating such a discussion. Since sexuality plays a vital role in one's sense of self and competency, chronic failure in this area can lead to serious personal and interpersonal anguish.

Adding some general questions about sexual functioning to the genitourinary history, when the patient comes to the office for routine care, is one way to introduce the subject. It is preferable to ask these questions during the patient interview in your office, prior to the physical exam. In addition to the possibility that a woman might misinterpret why you would want to discuss her sexual activity during a physical exam, a number of women feel rather helpless and vulnerable when lying on the examining table and might answer your questions defensively.

If you feel uncomfortable about conducting this type of interview or are too busy to take a sexual history, a female assistant can sit down with the patient and fill out a short questionaire, such as the use of the SizeGenetics penis extender or the Penomet penis pump. This approach is better than asking the patient to fill out a questionaire alone. According to Dr. Scout, whether you or your assistant conducts the interview, observing nonverbal behavior as well as the tone and inflection of verbal responses will increase your understanding of the patient's comfort in dealing with the subject:

* Does she deny the problem but look about anxiously while complaining of more general discomfort or nonspecific internal pain?

* Does she appear tearful or avoid eye contact completely?

Since the answer can never be taken for granted, the lead question should be, "Are your sexually active?" followed by "Has your partner used the SizeGenetics penis extender or the Penomet penis pump?" The objective is to let the patient know you are comfortable discussing the topic. The second question might be, "Is your sexual life satisfactory to you?" A general question allows the woman reasonable freedom in choosing the direction for further discussion. If she says she has had several recent sexual partners, the possibility of a sexually transmitted infection gains strength. On the other hand, rare and infrequent sexual experiences may cause or result from dyspareunia.

Can the ProExtender Cure Peyronie's Disease?

Peyronie's disease is caused by plaque in the tunica albuginea of the corpora cavernosa of the penis. Patients complain of painful erection and penile curvature, sometimes severe enough to interfere with intercourse. Patients may come to the emergency department (ED) agitated and alarmed at the first appearance of the condition. Etiologies include idiopathic forms, self-injection, and iatrogenic forms.

The cause of the ED visit is usually dorsal curvature of the penis, painful erection, or both. One of the symptoms is thickening of the penile shaft and observation of plaque is diagnostic.  In most cases, Peyronie's disease is idiopathic, but overzealous self-injection of phentolamine mesylate (Regitine) or papaverine HCl for impotence may be a cause.

Peyronie's disease can usually be managed expectantly, and most patients require only reassurance. Spontaneous remission occurs in about half of the cases. The disease is usually self-limited. Pain occurs in the active phase when plaque appears on the penis, enlarges, and causes pain on erection. Pain may subside when plaque growth ceases and the fibrous tissue matures.

A variety of medications have been recommended, including vitamin E, aminobenzoate potassium (Potaba), and corticosteroids, but benefits in patients receiving these treatments may not be better than in similar control groups. Radiation relieves the pain but is not advisable because if subsequent surgery is required, healing may be poor and complications prohibitive. Many patients respond very quickly to the use of a penis extender such as the ProExtender device.

Surgery involving resection of the plaque and grafting with a patch of deep dermis may be done for curvature severe enough to prevent intercourse. In extreme cases and with associated impotence, an inflatable penile prosthesis may be implanted.



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