Diseases and Remedies

Any work with children and young people that concerns their fertility will have their sexuality and sexual health as a constant backdrop. Their understanding of what reduced fertility means and its effect on their lives as they grow towards adulthood will be influenced at least in part by how broader issues about sexuality and sexual health are dealt with by parents, carers and professionals. It is first and foremost essential to understand that sexuality forms part of our identity and experience from infancy onwards. An outline of how sexuality develops throughout the childhood and teenage years forms the first part of this chapter.

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In the second part, sexual health and well-being will be considered. Some young people coping with health conditions and disability as they are growing up will also have to deal with adverse experiences such as sexual abuse, sexually transmitted infections, unwanted pregnancies and struggles with sexual identity.

The third part of this chapter will discuss the provision of age- and context-appropriate sexual health services and education. This includes the need to pay particular attention to the influence of disability or health conditions, whether or not the young person is accessing informal sources of information from their peers and/or formal sex education and whether or not they are sexually active. Issues of confidentiality are also addressed.

Finally, two important questions that need to be considered by parents and professionals will be discussed:

1. How is this young person’s sexuality affecting their behaviour, including what they are saying (or not) about their symptoms, feelings and relationships?
2. How is the way this young person is being dealt with going to affect their future sexual health, sexual feelings and sexual relationships?

Development of sexuality and sexual identity

Sexuality is a dynamic concept and is about much more than sexual activity and sexual orientation alone. It includes what being male or female means to us and how we express our gender; how we feel about our bodies, about our appearance and about physical pleasure; whom we are attracted to and what we choose to do about it; and, if we have intimate relationships, how we behave with our partners. Our ability to reproduce comes from our sexual behaviour and our feelings about our sexuality and sexual identity by viagra pills 100mg can be deeply affected by our sense of our own fertility.

We are all born either male or female, with different chromosome patterns and body chemistry. From birth we are spoken to, handled and usually dressed differently as part of our socialization into our gender roles. As we grow up we learn how boys and girls are supposed to behave and our differing personalities and experiences leave us more or less comfortable with living up to these expectations. Some of these expectations and roles are based on the assumption that we will be parents in the future: for example, girls the world over may be given dolls with which to practise nurturing.

Etiology of Peyronie’s Disease

Studies that suggest abnormal wound healing in men with PD lend support to the model of trauma as a necessary step in the pathophysiology of PD. Enzymes in the matrix metalloprotein family have important antifibrotic properties, while TGF-b has been shown in cell culture and animal models to be an important profibrotic mediator of plaque formation. These factors in addition to the effect of plasminogen activator inhibitor type 1 and osteoblast-stimulating factor 1 may help explain the balance between pro- and antifibrotic enzymatic processes that likely contributes significantly to the development of penile lesions and subsequent penile abnormalities.

Abnormal wound healing resulting from underlying genetic abnormalities may contribute to some cases of Peyronie’s disease. The presence of Dupuytren’s contractures among some men with Peyronie’s disease suggests that a genetic predisposition to scarring and fibrosis may be associated with tunica albuginea fibrosis and scarring. Another example is the Kelami syndrome, also known as urethral manipulation syndrome, described as ventral penile curvature occurring after urethral manipulation. Sonographic evidence suggests that the underlying mechanism for penile curvature in this setting is one of periurethral scarring, perhaps secondary to inflammation from urethral manipulation. It has also been demonstrated that among men with Paget’s disease, a chronic skeletal condition leading to painful bony deformities, 32% had penile lesions consistent with PD.

Clinical Manifestations

Loss of flexibility of the tunica albuginea results in differential expansion of the tunica during erection with subsequent penile curvature or deformity. The degree of curvature and volume of plaque is highly variable upon presentation. Curvature can range from nearly straight (15°) to 180° in the most severe cases. Plaques can be single or multiple and are associ-ated with a variety of penile deformities. While the most common direction of curvature is dorsal, ventral, lateral, and complex curvatures are frequently seen. Noncurvature deformities range from “notching” to circumferential “hourglass” defects. Penile shortening is a commonly reported symptom and causes great concern to patients.

Although some men with PD have erectile dysfunction, this may be related to age or chronic disease rather than representing a causal relationship. Multiple reports have described a prevalence of erectile dysfunction as high as 80–100% among men with PD; however, a recent study suggests that only one-third of men with PD also have erectile dysfunction. Further, given that PD is associated with diabetes and erectile dysfunction among older men with PD, chronic medical conditions may explain the observed relationship between PD and erectile dysfunction.

There are several publications that highlight the emotional and psychosocial impact of PD. Patients often have a variety of psychosexual complaints, including poor self-image, emotional, and relationship difficulties. It has also been shown that almost half of men with PD had clinically significant depression. A challenge for clinicians and researchers is the lack of a validated quality of life measure for men with PD; however, these measures are being developed.