Q. My 52-year-old husband has been having a lot of problems. First, he wasn’t able to get an erection and was having pain in his lower abdomen. His doctor treated him for prostatitis. It helped relieve the pain, but then he got worse. He went to a urologist and was put on Flomax. He has been able to get erections, but they are painful, especially at the tip.

After taking this medicine for about a month, he began experiencing a curved penis. He went back to the urologist who told him he had Peyronie’s disease and said there was nothing he could do and handed him a brochure.

He used to take meds for hypertension and high blood pressure. He drinks two or three glasses of Scotch every night. He is now taking two vitamin E pills a day. Please send us any information you can.

A. Your husband certainly has more than his share of problems. I hope I can provide some useful information on what are two different but associated problems.

Erectile dysfunction or impotence is defined medically as the inability to achieve or sustain an erection of sufficient rigidity to permit sexual intercourse. Impotence is thought to affect 10 million American men, and it is age-related.

While some cases of impotence are psychological in origin, especially in younger men, most impotence is associated with medical or physical problems.

Because blood flow to the penis is critical to erection, vascular disorders such as atherosclerosis can cause impotence. Damage to nerves to and from the penis can also produce impotence. Such damage may be due to injury, diabetes, stroke and alcoholism.

Drugs are implicated in as much as 25 percent of impotence. Drugs known to have an impact include antihypertensives, antidepressants, sedatives and alcohol. Even pain, such as from prostatitis, can cause impotence.

Flomax (tamsulosin) is given to improve urinary flow and reduce the symptoms of benign prostatic hyperplasia, the increased growth of the prostate. The side effects of tamsulosin include decreased sexual urge.

Your husband’s medical history and the drugs he’s taking, including alcohol, may be implicated in his erectile dysfunction problems. The first step is to work with the urologist to find the cause or causes and deal with them.

Your husband’s second problem, Peyronie‘s disease, is a medically and psychologically traumatic disorder in which a fibrous plaque forms in the covering around the spongy erectile tissue of the penis. This plaque, similar to scar tissue, causes a curvature of the erect penis that may make sexual intercourse difficult, painful or impossible. Peyronie’s disease can lead to erectile dysfunction.

The cause of Peyronie’s disease is unknown, but it’s thought to be congenital or initiated by genital trauma. Some investigators see an association between Peyronie’s disease and hypertension and high cholesterol, among other conditions.

For milder cases, a number of nonsurgical therapies are available, but all of them appear only partially successful. Vitamin E and potassium para-aminobenzoate have long been suggested as treatment for Peyronie’s disease.

Injection of the calcium channel blocker, verapamil, directly into the plaque has been shown to be effective in some cases. Effective surgical procedures for this condition include incision of the fibrous material and venous patch grafting.

The other good news on Peyronie’s disease is that it often goes away by itself.

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