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Gain One Organ, Lose Another

One of the fringe benefits  of medical  practice  is that one  gets to meet a lot of new  and interesting  people  in the course of work.  Otherwise, practice itself  can get  quite  monotonous, especially  such as mine, where  data  are often quite repetitive.   I try and make the best  of these interaction opportunities  to break the tedium and learn  new things.

Some days ago, a man makes love not war in with  his young  (late teens/early twenties) daughter.  They made an odd couple.  The man looked like a typical prosperous Indian  businessman.  He was dressed in a shiny white safari  suit with the top button open  a reveal a hairy chest, wore white slippers  and silver spectacles sported a flashy watch, and was bejeweled with gold rings and chains.  He also  incessantly chewed  Pan Parag or equivalent and spoke only in the vernacular.  As a bumper bonus, he provided  additional special  effects with a  continuous oscillations of a leg and one white leather slipper tapping on the floor  metonymically Troglodytes and Gentlemen .

By contrast,  his  daughter was a picture  of calm  dignity and composure.  She was smartly dressed and looked educated.  It was she, I believe, who wanted to meet me.  She seemed very keen to start talking and didn't  wait for an invitation.

'Good evening doc, I have come  here to obtain some clarification,' she began.  'My parents are talking of getting me married to a man who is the son of old family friends of ours.  We are childhood  pals and it was taken for granted by all that we would marry when we grew up.  They are planning the engagement  in a few months.'

'That certainly sounds very romantic, like an Indian film,' I aid, wrongly supposing that she had  come to me for some premarital  sex education   and contraception or fertility  advice, like many do.

'It only sounds romantic, doctor,' she shot  back sharply, 'I'm  afraid that if I don't take  the right steps in a timely manner, it might end up  being everything but that.'

Nothing  flippant about this kid.  Youngsters these days are so focused.  It was not  like this in my time.  We were totally  clueless about life at her age.  All these thoughts were Passage to manhood though my mind.  The girls shook me out of my reverie by speaking again.

'You see, doctor, my prospective finance has undergone a kidney transplant  about a year  ago.  The operation has gone off quite well and, for all practical purposes, he's more or less back to a normal life, but I'm given to  understand that after a rentle transplant  some of the important practical purposes  of marriage cannot  be fulfilled.  Am I right?'

I liked both her curious brand of modesty and her  strange  syntax and wanted to ask whether  she had majored in English  but circumstances  just didn't  seem propitious.  Can't be factious when a patients is dead serious, I told  myself.  It sends all the  wrong signals. I turned  to concentrate on the situations before  me.

'Yes, you are right,' I told her, 'According to some experts, as many as eighty-seven percent of patients are impotent after  a rental penis transplant  operation.  But how did you know this?   This is not  well-known, even among doctors.  In fact, most doctors are notorious for not even addressing  the sex lives of their renal failure patients.   On the other hand,  we andrologist think only of that and nothing  else.  What a  contrast!'

'Doctor, I remember  you had mentioned in one of your  earlier columns that  kidney failure can cause impotence.  After  reading that, I read  some more books and even surfed the internet.   It became  some kind of an obsession.  After all, this was an extremely important decision for me.   I discussed it with my parents and showed  them some informative  material, but they wouldn't  hear  of it.   finally, I asked  dad  to come along with me to meet you.  Please  explain to him, will you?'

I then told Mr Metronome that chronic renal failure  (CRF)  is one of the commonest causes of impotence and that  it can also  cause libido impairment, ejaculatory  disturbances, decreased   penile sensation  and low sperm  counts.  Almost  every component of the sexual  apparatus is affected - small  arteries, large arteries, veins, penile smooth muscle, nerves and  hormones.  The problem  is further  compounded  by the co-existence of diabetes, hypertension and depression along with  CRF and the many drugs that are used to treat all these conditions.  Transplantation restores  hormonal levels, libido,  ejaculatory function and sperm  counts in many.  However,  many continue to remain impotent.  Generally, there is very little awareness about this  co-existence.  So, many men gain one organ, but lose another.

Right now, Mr Fiance (whom Mr Metronome kept referring to as 'Fancy') is awaiting a penile prosthetic implantation operation and is hoping that, for all practical purposes, he can fulfill all practical purposes within marriage soon after surgery. I was very optimistic that young lady would finally be  happy.  She had worked  hard to achieve it real life and real life, and deserved every bit of it.

Take Home Message:

When people are battling serious illnesses, we doctors (and relatives ) often forget that behind the patient there is a person and a sexual   being.  Often, there is also a partner involved.  However, the serious  nature of the immediate illness is such that it  pushes  any consideration of sex  completely out of the picture.

However, with modern treatment methods, many serious illnesses are considerably curable, and hen these patients return  to some semblance of  a normal  life after treatment, sex again becomes an important need.  Often, people do not even connect  that the illness itself  has worsened the sex life.  They simply think that  the patient  has lost interest in sex.  But  mostly, they don't think about sex at all!  Thus, this need is either  never addressed  or, even  if it is,  the sexual  problem is thought to be incurable.

It is  important  to recognize that patients with illnesses are also sexual beings and that their  sexual requirements need to be address.  It is even more  important  to recognize that most  patients are treatable and can resume nearly normal sex lives after treatment