10 Vital Signs Your Doctor Might Miss

SOME MEDICAL CONDITIONS CAN BE MISDIAGNOSED OR COMPLETELY MISSED, SO IT’S VITAL TO KNOW ABOUT MORE UNUSUAL SYMPTOMS

1 Ovarian cancer

THERE are 4,000 deaths from ovarian cancer in the UK each year, according to the charity Cancer Research UK. If it’s detected early, survival rates can be up to 80 per cent. But, tragically, in 60 per cent of women, the condition isn’t diagnosed until in its advanced stages.

Recent research reveals that symptoms appear earlier than once thought but are often mistaken for minor conditions such as irritable bowel syndrome. So be extra vigilant if you have a personal or family history of ovarian, breast or colon cancers, are post-menopausal and you’ve never had children.

Watch out for: Stomach pain, bloating, diarrhoea, constipation, back pain, tiredness and needing to pass water more often than usual.

Check it out: See your GP as soon as possible. You should be given an internal examination and possibly diagnostic scans. If you have a family history of the disease, ask about screening.

2 Underactive thyroid

THIS affects one in 50 women and one in 1,000 men, and may be hereditary or triggered by stress, infection, pregnancy or medication. Symptoms are often put down to depression, especially postnatal depression, or other hormonal problems.

“Confusion arises when thyroid hormone levels test normal but the body can’t use them properly,” says Professor Nadir Farid, of London’s Welington Hospital.

Watch out for: Tiredness, weight gain, mental fatigue, dry skin, thinning hair, depression, constipation, heavy, irregular periods and sensitivity to the cold.

Check it out: This is easily controlled with medication but if not diagnosed it can lead to heart disease, infertility and anaemia. See your doctor for a blood test. If results are normal but you still have unexplained symptoms, ask for a referral to a hormone specialist.

3 Whooping cough

FAR from being an “extinct” disease, a recent Oxford University study found that 40 per cent of children visiting their GPs with persistent coughs showed signs of the disease. And, according to the Health Protection Agency, one in four youngsters admitted to hospital didn’t receive correct treatment.

Watch out for: A persistent cough with a whooping sound and possibly vomiting.

Check it out: Make sure your baby is fully vaccinated as whooping cough is most dangerous in children under a year old, potentially leading to pneumonia and death. Vaccination protection isn’t life-long so if you or your child gets the above symptoms, ask your doctor for a blood test.

4 Carbon monoxide poisoning

LEAKS from faulty gas appliances, fires and central heating result in 30 carbon monoxide poisoning-related UK deaths a year. “You can’t hear, see or smell it and the symptoms of mild poisoning may be similar to cold viruses,” explains GP Dr Rob Hicks.

Watch out for: Headaches, nausea, dizziness, sore throat and dry cough, followed by tiredness, confusion, difficulty breathing, memory loss and co-ordination problems.

Check it out: Poisoning can be confirmed by a blood test. Prevent leaks with a carbon monoxide alarm and have chimneys, flues and gas appliances checked every year by a CORGI registered fitter.

5 Hepatitis C

THE symptoms of this potentially fatal liver disease often don’t show for years. According to the Hepatitis Trust, 500,000 Brits are infected but only one in seven know it.

It’s passed on through infected blood so you could be at risk if you had a blood transfusion or organ transplant before July 1992, I injected drugs, had a tattoo, piercing or acupuncture with dirty instruments. You can also catch it from unprotected sex.

Watch out for: Tiredness, sore muscles, headache, nausea or loss of appetite. Around a third of the patients develop cirrhosis of the liver up to 20 years after the virus has been caught, leading to liver failure.

Check it out: If you’re at high risk, get a blood test. Drugs cure 60 to 80 per cent of sufferers.

6 Heart disease in women

WOMEN complaining of chest pain – a key heart disease symptom – are less likely to be given investigative tests and more likely to die of the disease than men, according to a study by University College London.

It’s traditionally thought of as a male ilness despite the fact that it is responsible for the deaths of one in four women, whose symptoms can be mistaken for stress or depression.

Watch out for: Dull chest pain and feeling generally unwell are more common in women. Men are likely to get the “classic” sharp chest pain and pain down the left arm. Other signs include breathlessness, nausea and anxiety.

Check it out: “See your GP for a heart health assessment if you have a close relative who suffered from heart disease before 55 if a man or 65 if a woman,” says cardiac nurse specialist Michaela Nuttall.

“Other risk factors are high blood pressure, high cholesterol, obesity, smoking, drinking, fatty diet, inactivity and stress.”

Seek medical help if you experience symptoms listed above.

Treatment may involve drugs or a procedure called an angioplasty to widen blocked arteries.

7 Parkinson’s disease

FIVE to 10 per cent of patients with this degenerative disease of the nervous system, are misdiagnosed with other conditions such as rheumatoid arthritis or frozen shoulder, according to medical journal Neurology. And the Parkinson’s Disease Society claims that only one in four GPs has any expertise in the condition. Risk factors include age and exposure to pesticides. It’s also more common in men and can be hereditary.

Watch out for: Trembling on one side of the body, such as the hand when at rest, stiffness, stooped posture, difficulty walking, poor sense of smell and depression. However, 30 per cent of sufferers may not experience a tremor.

Check it out: Ask your GP to refer you to a neurologist for a definite diagnosis. If the symptoms don’t improve with medication, get a second opinion.

8 MS

MULTIPLE sclerosis destroys nerves and damages the brain’s messaging system, affecting movement, speech, sight and memory.

There are 85,000 UK sufferers and diagnosis is difficult as symptoms may come and go. There’s also no definitive test and it’s often confused with other auto-immune diseases (where the body attacks its own tissues) or chronic fatigue syndrome. If a close relative has MS, your risk may be slightly higher.

Watch out for: Blurred or double vision, fatigue, tingling, dizziness, lack of co-ordination, tremors and concentration problems, typically between the ages of 20 and 40.

Check it out: Early treatment can slow the disease’s progression. You should be given an MRI (magnetic resonance imaging) scan and be referred to a neurologist.

9 PCOS

UP to one in four women have, polycystic ovarian syndrome -multiple cysts on the ovaries – but it only causes problems in 15 per cent. The condition is due to a hormonal imbalance that sometimes prevents ovulation, reducing fertility. However, it’s often missed because it tends to start in teenage years and many of the symptoms are common in puberty.

Watch out for: Weight gain that’s difficult to shift, irregular periods, acne, infertility, excess body or facial hair.

Check it out: Correct diagnosis through blood tests and ultrasound is important because PCOS can increase the risk of miscarriage, coronary heart disease, diabetes, depression and fatty liver.

According to Prof Farid: “The contraceptive Pill is often prescribed to control symptoms but it doesn’t address the real problem, which is insulin resistance. If sufferers lose weight, they’ll lessen this resistance and the drug Metformin can further lower’ it.”

10 Meningitis

BACTERIAL meningitis causes inflammation of the brain and may lead to blood poisoning. It’s easy to miss because early symptoms are similar to flu – prompt treatment is vital. Children under one or young adults aged 15-19 are most at risk and it’s more common in winter.

Watch out for: High temperature, fever, vomiting, headaches and tiredness. Babies may make a high-pitched moan, have a blank expression, blotchy complexion or bulging fontanelle (soft spot on the head). Children or adults may have a stiff neck, aches and pains, confusion and dislike of bright lights. Another possible symptom is a rash that doesn’t go when you press on it with a glass. Check it out: Go straight to your nearest accident and emergency department if you’re concerned. If you’ve seen a doctor and are still worried, don’t be afraid to ask for a second opinion as the condition can be fatal. Emergency treatment with antibiotics and hospital visits are vital. Log on to meningitis-trust.org or call the 24-hour helpline on 0800 0281828.

Fake viagra

Email Systems, a company that measures spam emails on the INTERNET, reports that in the first three months of 2005 two in five spam emails were offering drugs for sale. As the volume of spam is now almost 90 per cent of all email sent, that means one out of every three emails sent is offering you cut-price drugs over the net.

fake viagra

In September 2003, Dr Nic Wilson, a researcher at the University of London, announced to the British Pharmaceutical Conference in Manchester that she had been testing samples of internet-bought it accurately measures the ingredients in each tablet. The result was that half of the pills were lakes. ‘The user runs the risk of poor quality and possible toxicity, not to mention the fact that there is a high probability that the tablets have no clinical effect,’ she told her audience, who probably looked around the room to see who was blushing – Brits being the largest consumers of Viagra in Europe.
It’s comparatively easy to set up a Viagra factory, and some crooks have gone into the business in a big way: an example is 44-year-old Londoner Allen Valentine, convicted in November 2004 at Harrow Crown Court and sentenced to five and a half years in prison for supplying class C drugs. In effect, he was sentenced as if he had been supplying large amounts of cannabis.
His factory in Wembley was more than just a cement mixer: it could create 500,000 tablets a day. On the side, he was also making steroids and anti-stress medication, and a great deal of cash: the day before his arrest in April 2004. he had offered cash for a £1.25 million house and bought a new jeep.
Valentine knew how much people wanted Viagra – he was previously a rep for Viagra’s manufacturer, Pfizer.
The little blue pill is a common find for the drugs squads of Europe, the US and Asia. In January, £1 million of fake Viagra was found in an abandoned car outside Glasgow. ‘It is quite common to recover one or two thousand fake Viagra pills. They are usually found along with Class A drugs like cocaine, heroin and ecstasy,’ said Detective Sergeant Ken Simpson of Strathclyde Drugs Squad.
This is no cottage industry: Richard Widup recalls a case from his time at the FDA: ‘It was over the Christmas holidays 2002, in Southern California…  There were 700,000 counterfeit Viagra.

Life after phentermine

Doubtless many of the millions of Americans who have been using dexfenfluramine (Redux) or or fenfluramone (Pondimin, better known in combination with phentermine, as fen-phen) to lose weight will regard this week’s withdrawal of both drugs from the market as bad news, indeed. The cloud, however, is not without its silver lining.

There were, after all, very good medical reasons to remove the drugs from public consumption. The reason the FDA asked manufacturers to stop selling the drugs – and the reason the manufacturers, including the French company that distributes the drugs internationally, complied – was because there is strong evidence they cause heart-valve problems. The FDA reviewed the records of 291 patients and found that echocardiograms, which measure heart-valve function, showed abnormalities in the valves of 30 percent of them – none of whom had yet experienced any symptoms. Thirty percent is a very high percentage, much higher than the FDA expected to find. And heart-valve damage is no laughing matter. So, the good news is that the withdrawal will most likely save many people from some very serious damage to their health.

Of course, there are people whose health is seriously endangered by obesity itself, and who have had so little success losing weight through diet and exercise that Redux and fen-phen have seemed the last, best hope. For them, there are other medical possibilities, including the appetite suppressant phentermine, which is the “phen” part of fen-phen. And new diet drugs are in the offing, including one that inhibits the absorption of fat by the body.

Unfortunately, all diet drugs, new and old, including even so-called “natural” fen-phen, which contains the potentially dangerous ephedra, could be dangerous in one way or another. And, while Redux and fen-phen have unquestionably been helpful to dieters, even if only as a sort of reassurance and reminder to stay on the diet and keep up the exercise, diet drugs are no magic bullet. As doctors who have prescribed them clearly understand, even with the drugs, the keys to successful weight loss are diet and exercise.

The depressing truth is that for all people looking to lose weight, a restricted diet of some kind and strenuous exercise of some kind are absolutely necessary, drugs or no drugs. And for most people looking to lose weight, they are, simply, sufficient. Though the danger of diet drugs will pose a dilemma for doctors treating the dangerously obese, it is not the end of the world that the non-dangerously overweight and the not-at-all overweight, those afflicted with the American obsession to (almost literally) get down to the bare bones, are left once again with those two dreadful old standbys.

Overweight and Life Expectancy

Applicants for life insurance usually undergo a medical examination. In the Build Study of 1979,¹³⁶ weight was measured in 86.1 to 88.5 percent of the 3,997,650 men and 592,509 women on whom policies were taken out. The analysis of such data, with all of its limitations, provides the major retrospective studies on the effects of body weight on mortality and morbidity. One limitation is that persons who buy life insurance may not represent the American population. They earn above-average income, are Caucasian, are free of serious medical diseases, and are usually engaged in “safe” occupations. The mortality rate among insured individuals is only about 90 percent of the rate for the entire population at all ages between 15 and 70.¹⁷

The information obtained from analysis of the life insurance experience is valuable for two reasons. The sample size is large, comprising several million individuals. Second, the individuals are continually followed until death, an event in which the life insurance companies have a financial interest. Figure shows the relation between excess mortality and deviations in body weight. The overall mortality rate—that is, the ratio of deaths to the total population of insured lives—was taken as 100. The

insured individuals were subdivided into subgroups based on the percentage deviation from the mean for the entire group. The death rate in each subgroup was then compared to the population as a whole and expressed as deviation from the overall mortality of 100. The minimum death rate occurred at a body weight that was slightly less than the average weight for the entire population. As body weight, expressed as the BMI (kg/m²), increased, there was a progressive increase in “excess mortality.” There was also a small increase in excess mortality with very low body weight. This was more pronounced in the younger age group than in the older one and may reflect a higher number of smokers. The excess mortality among those with life insurance was due to diabetes mellitus, digestive diseases, hypertension, cardiovascular diseases, and cancer.

Comparison of the Build and Blood Pressure Study of 1959¹³⁵ with the Build Study of 1979¹³⁶ reveals several facts. Body weights of insured Americans were higher in the recent study. However, the curvilinear relation of excess mortality to BMI was evident for all age groups in both studies. Unfortunately, few grossly obese individuals were insured in either study. The implications from the life insurance studies is that obesity is hazardous.

Drenick and associates³⁶ provided a clear insight into the effects of gross obesity on life expectancy. They reviewed two hundred morbidly obese men whose average weight was 143.5 kg, who were admitted for a weight-control program and followed for an average period for seven and a half years. Of these men, 185 were followed until death or termination of the study. The age range was 23 to 70 years with a mean of 42.7 years. The mortality rate was higher at all ages when compared with the mortality expected for the general population of U.S. males. In men aged 25 to 34, the excess mortality was 1,200 percent! In those aged 35 to 44, the excess mortality had declined to 550 percent, and in men 45 to 54, it was 300 percent. In men aged 55 to 64, the excess mortality was only double that of the normal U.S. population. This study showed that the excess mortality associated with obesity is greatly increased in the younger age groups and that excess mortality is substantially higher in grossly obese persons.

Effects of Obesity on Health and Happiness

The medical and social problems identified with obesity can be manifested in many ways. Obesity may decrease longevity, aggravate the onset and clinical progression of maladies, and modify the social or economic quality of life. On the positive side, weight loss can reverse all or most of the disadvantages of obesity.

Most of the data relating health and obesity have been collected and analyzed in terms of overweight. Overweight refers to deviations in body weight from some “standard weight” related to height. Being overweight, however, does not necessarily mean being obese. This distinction is most obvious in athletes but may also apply to other groups and individuals with body weights only slightly above the upper limits of normal. The correlation between measures of body weight such as weight divided by height, percentage overweight, or body mass index (wt/ht²), have a correlation of between 0.7 and 0.8 with body fat measured by other more precise laboratory methods. Of these indices, the body mass or Quetelet index has the highest correlation with body fat. In this chapter the following definitions will be used.

Penile Injection

Puncturing one’s penis with a needle is not for the squeamish. Piercing the penis with a needle and then injecting a chemical to enhance one’s sexual potency sounds more like a bizarre, sadomasochistic nightmare from the annals of Krafft-Ebing Psychopathia Sexualis than a doctorrecommended treatment of impotence. Nevertheless, many men, with guidance from their physicians, practice self-injection of the penis to achieve an erection. Three types of medications — phentolamine (an alphablocker), papaverine (a smooth-muscle relaxant), and alprostadil (a prostaglandin) — may be loaded into syringes and injected directly into the penile erectile chambers to provoke an erection.

Phentolamine, papaverine, and alprostadil are all effective in stimulating erections because they overcome neurologic signals that normally keep the penis in a limp or flaccid state and help encourage the release of intrapenile chemicals like nitric oxide and cyclic GMP to increase blood flow into the corpora cavernosae. Neurologic control of erections is vested in the sympathetic nervous system.

To understand how the sympathetic nervous system works, it is useful to create a simple scary example. Imagine that you are alone at night walking down a dark street. There is no sound. Then, as you are absorbed with your thoughts, someone comes up behind you and says, “Boo!”

Your sympathetic nervous system immediately swings into action to cause, among other reactions, an increase in pulse rate and blood pressure. The change in pulse and blood pressure is caused by internally produced adrenalinelike compounds with unique properties designated “alpha” or “beta.” Beta forces cause you to have palpitations and an increase in pulse rate, while alpha influences raise your blood pressure.

What does this have to do with erections? The penis is richly endowed with extensions of the sympathetic nervous system, specifically nerves of the alpha type. Alpha signals either facilitate or inhibit normal erections.

When the alpha forces dominate, the penis remains at rest. An injection of a medication that blocks the erection-inhibiting alpha nerves makes it possible for a full and unrestrained flow of blood to be directed into the

erectile bodies of the penis. Medications like phentolamine, an alphablocker, and prostaglandin El, a muscle relaxant with probable alpha-blocking activity, cause erections by blocking the nerve signals that maintain the penis in a limp state.

It is somewhat more difficult to understand exactly how papaverine works. There are no papaverine receptors in the penis. Papaverine, unlike alpha-adrenergic compounds or prostaglandins, is not made by the body. However, papaverine has one characteristic that is useful in inducing an erection; it is a smooth-muscle relaxant.

The body has two types of muscles, striated and smooth. Striated muscles are literally striped in appearance and are, for the most part, under voluntary control. The muscles of the arms, legs, and face are striated muscles. Smooth muscles are not under volitional control. For example, the muscles in the intestines are smooth muscles. The muscles lining the penile blood vessels that must dilate for an erection to occur are also smooth muscles. It is presumed that papaverine induces an erection by causing these intrapenile smooth muscles to relax, thereby allowing or encouraging increased blood flow into the penis.

To be fully effective, alprostadil (Caverject) or other similar medications must be injected directly into one of the penile erectile bodies, the corpora cavernosae. (The medication will naturally migrate over to the other side of the penis so that symmetrical erection is acquired.)

A cross section of the penis illustrates the corpora cavernosae surrounded by the thick outer fibrous sheath (tunica albuginea).

COST OF PENILE PROSTHESIS SURGERY

Penile prosthetic surgery is expensive. The cost of the prosthesis, hospitalization, and urologic surgeon’s fees can be as high as $10,000 to $12,000. This figure is applicable to those men who have their surgery and three to five days of postoperative care in the hospital. Most medical insurance plans cover the cost of surgery only for patients with documented organic impotence. With improved anesthetic skills and pressure to cut down on the high cost of hospitalization, some urologists have been experimenting with same-day ambulatory outpatient surgery. It is too early to determine whether this novel approach will safely replace the more traditional threeto-five-day hospitalization.

THE FUTURE OF PENILE PROSTHESIS SURGERY

The initial brouhaha attending the introduction and early years of penile prosthesis surgery has subsided. It is now possible to reflect and cast a sober eye on the role of penile prostheses in the treatment of impotent men. It is clear now that surgical skills alone are not enough to solve the problem of impotence.The penile prosthesis industry is highly lucrative and competitive. The five penile-prosthesis manufacturers collectively accounted for $60 million in worldwide sales up to 1998.It is too early to know whether the availability of Viagra will dampen enthusiasm for penile prosthesis implantation. Still, the most optimistic estimates indicate that Viagra is effective in restoring erectile function in about 65 percent of impotent men. Among those 35 percent of impotent men who have a suboptimal response to Viagra are men who have become impotent as a result of:

Thus, the remaining 35 percent of men with erectile dysfunction who do not respond satisfactorily to Viagra are precisely those men who have, in the past, been considered to be ideal candidates for penile prosthesis surgery. However, these are the same men who may also respond to penile injection therapy or intra-urethral alprostadil (medicated urethral suppository, or MUSE) therapy. With so many treatment options now available to correct erectile dysfunction, significant adjustments in strategy will be needed to decide exactly what treatments are best for the 30 percent of men who do not benefit from Viagra.

CANDIDATES FOR PENILE PROSTHESIS SURGERY

Prostheses have been implanted in men with virtually every known type of impotence, but some men are more appropriate candidates for surgery than others. Urologic surgeons prefer to implant devices in men whose impotence is a result of a physical cause, either neurogenic or vasculogenic. Included in the category of neurogenic impotence are men with diabetes mellitus, spinal-cord injuries, and multiple sclerosis, along with paraplegics and men whose pelvic nerves have been damaged or severed during prostate or lower abdominal surgery. Vasculogenic impotence applies to men with either decreased penile arterial inflow or increased venous outflow; vascular surgery is the preferred form of treatment for these men. But they are not always willing to go through the somewhat more complex surgical procedures and may elect prosthetic implantation instead.

As noted, patients with Peyronie’s disease have no difficulty achieving an erection. The problem is that the erection bends, so the penis deviates, often creating a J-shaped erection unsuitable for intercourse. Peyronie’s disease occurs when fibrous bands grow in the outer lining of the penis and tug at the penile shaft. The bands can be removed surgically, but this is only a temporary solution because these strictures tend to recur at the same or different locations in the penis. Implanting a prosthesis is often the only way to circumvent the problem.Men with endocrine disorders, whose potency can be restored with appropriate hormonal therapy, and men with overt psychologic problems, who require psychotherapy, psychiatric medications, or both, are the only groups to whom physicians do not routinely offer penile prosthetic implants.

SATISFACTION FOLLOWING PENILE PROSTHESIS SURGERY

Although surgical success rates for some devices now approach 90 to 95 percent, patient satisfaction does not parallel this impressive figure. A major problem is disappointment with postoperative penile length and width. Some men never attempt intercourse after the prosthesis is implanted; others have intercourse for only a brief time and then abandon sexual activities. Additional areas of disaffection with prostheses have surfaced in response to specific questions.

The majority of urologists are men, and in the beginning, the male perspective distinctly colored the reported results of prosthesis surgery. Female health-care professionals saw things differently. They approached the issue of satisfaction after implantation by interviewing both partners. Some couples were not having intercourse at all. Of those who were having intercourse, 25 percent reported restriction in positions because of the decreased penis size. Fifteen percent of the men experienced diminution of orgasmic intensity. Still, 79 percent of men said that they would, if given the opportunity, undergo the operation again. Only 59 percent of their partners had no hesitation.

Some urologists claim that satisfaction depends on the type of prosthesis, with IPP recipients being generally more satisfied than those who receive other prostheses. Because they are easily concealed and readily activated, one would have anticipated that the multicomponent IPP would have emerged by now as the dominant, if not the only, penile prosthetic device implanted.

This has not turned out to be the case, for two reasons. Significant problems with the internal hydraulics of IPPs remain, and mechanical failures are common. Perhaps more troublesome is the fact that a certain amount of manual dexterity is required to inflate the IPP.Originally, in an effort to mimic the genital caressing that is a natural component of sexual foreplay, the man’s sexual partner was encouraged to play an active role in pumping the scrotal bulb so that fluid could be transferred from the abdominal reservoir to the prosthesis, a maneuver intended to mimic a stimulated erection. This has not been as warmly embraced as expected.Sexual partners are often unwilling to participate in the pumping procedure. Some are simply not deft at manipulating the scrotal bulb. As a result, inadequate amounts of fluid are transferred from the reservoir to the prosthesis shaft, and a suboptimal erection ensues. In such cases, failure of the device has been ascribed not to mechanical problems of the unit itself but to the inadequate level of participation of sexual partners. Those who have been unwilling to become involved as vigorous squeezers of the scrotal bulb have been decried as “timid pumpers.” Other factors may also have a significant impact on postoperative sexual satisfaction. Any of the following put the couple’s satisfaction at risk:

Obese patients are often displeased following penile prosthesis surgery because the length of the unit protruding beneath their lower abdominal fat pad is limited. Most prostheses are approximately eight inches in length. If there is an extensive overhanging fat pad, then perhaps only an additional four inches of rigid penile tissue will protrude for purposes of sexual intercourse. If the patient’s partner is also obese, it will be very difficult for the couple to find a position in which penile-vaginal penetration and adequate vaginal containment is possible. For obese couples, postoperative sexual gratification may be limited.

Inappropriate expectations are high on the list of reasons for postoperative patient-partner dissatisfaction. The prosthesis provides only the penile rigidity necessary to achieve vaginal penetration. Patients who anticipate

that the equipment will allow them to recapture the real, or imagined, sexual prowess of their youth are likely to be displeased.

Patients whose impotence is attributed to psychogenic factors do not derive as much long-term benefit from prosthetic surgery as those whose impotence is caused by either neurogenic or vasculogenic factors.

On occasion, impotent men have sexual problems other than erectile dysfunction. Lack of spontaneous arousal, limited libido, and ejaculatory disorders are not corrected by penile prosthesis implantation.

The level of preoperative patient-partner interaction is a critical determinant in evaluating postoperative satisfaction. If, for example, the female partner has her own sexual dysfunction, such as pain during intercourse, then she may be fearful of experiencing vaginal penetration again. A man may choose to have a penile prosthetic implant without notifying his partner. Such a decision is commonly interpreted as a rejection of the partner. In addition, some women are fearful that their previously impotent partners, now outfitted with penile prostheses, will seek other lovers. Limited studies exploring this question have indicated that penile prosthesis recipients are no more susceptible to seduction than other comparably aged potent men, nor do they routinely seek out new sexual opportunities more often than their potent peers.

On the other hand, some female partners of impotent men, frustrated after long periods of sexual abstinence, may pressure the men into surgery. Any discordance in patient-partner desires for penile prosthesis surgery is considered a major risk factor for postoperative dissatisfaction.

Couples who have distanced themselves sexually from each other and have ceased hugging, touching, and all sensual and erotic contact may not be able to retrieve all aspects of normal sexual function merely by placing a prosthetic rod in the penis. Clearly, satisfaction is maximal only when both partners are involved in all discussions and decisions from the beginning.