An Irish GP is helping people across the world with sexual dysfunction issues through his online practice, writes PRISILLA LYNCH
WHILE WE have undoubtedly become much better at discussing our health issues in Ireland, sexual health is still a somewhat taboo area, particularly when there is a problem.
It is not surprising, therefore, that many patients choose to deal with contraception issues at a family planning clinic or attend a hospital STD clinic if they suspect they have caught something rather than consult their family GP.
When Irish patients suffer sexual dysfunction, such as reduced libido or erection problems, they often just feel it is too personal to discuss with their own doctor or is not urgent enough to go to a specialist clinic.
That is what Kildare GP Dr Andrew Rynne's dedicated online medical service aims to address. His website, doctor rynne.com, is an e-consultation service run by a fully accredited GP – as distinct from a lot of the unvalidated websites that patients should rightly be wary of. Rynne's service offers people anywhere in the world, support, advice and a trained opinion on whatever medical issues they may be dealing with for a set fee at the click of a mouse. It specialises in sexual medicine, but can also deal with any other common general practice issues.
“It works like this: the visitor to my website asks a free question to do with their concerns. If I think I can help I send them a standard medical questionnaire to fill out that better allows me to fully understand what their problem is. If it is not an area of medicine that I feel I can help with, then I say so and that’s the end of that. Honesty is essential,” he says.
The most common questions asked by younger men using his website are to do with erectile dysfunction and premature ejaculation. In older men, it is often to do with loss of libido and about the wisdom or otherwise about testosterone replacement therapy.
The most common questions that women ask are to do with loss of libido, loss of sexual response and anorgasmia (where a person cannot achieve orgasm). Use of antidepressants and the menopause often play a role in all of this.
“I have website visitors and clients from all over the world. This is what makes this practice so endlessly fascinating and challenging. I thought that we in Ireland were sexually oppressed, or at least that we used to be. However, we pale into insignificance when you try to help people from the Middle East where Hinduism and Islam religions prevail,” says Rynne.
“I get men with massive guilt problems about masturbation and semen loss. They develop a serious sexual neurosis called Dhat syndrome, which is a miserable, incurable, lifelong condition and is endemic in parts of Asia.
“Then I would have women preoccupied about virginity before marriage and how to feign that noble state of affairs, so as not to be found wanting on their special night. Many other women in these countries suffer from vaginismus.
“And yet at the end of the day we are all the same, all sexual beings. I am actually learning as I go along to tell you nothing but the truth.”
Rynne’s service does not cover STDs because diagnosis requires blood tests and hands-on examination. Nor does he provide online prescriptions as he is licensed to practice only in Ireland, so there would be a risk that something he prescribed could interfere with another medication the patient was on that he did not know about.
Medical practitioners have traditionally been resistant to the idea of practising medicine over the internet, but Rynne, a veteran GP with more than 40 years’ experience who has long been known for his pioneering ways, was quick to spot the potential.
In 1974, he was the first Irish doctor to perform a vasectomy in Ireland, which was controversial at the time, while in the 1980s he was instrumental in helping force changes in Irish legislation to allow the sale of condoms. He is also a past chairman of the Irish Family Planning Association.
“About 10 years ago, once the penny dropped about the power and potential of the internet as a global information highway, it became obvious to me that it will have a serious role to play in medical consultation into the future. Where the internet and medicine is failing is to regulate the online pharmacy business, which has huge potential to do untold damage in terms of addiction and inappropriate treatments.
“Also, dangerous medical misinformation is a problem. But this is not going to be reduced by doctors decrying online consultation. What we need to do is get in there and fight back.”
But surely the face-to-face patient- doctor relationship is one of the most rewarding aspects of practising medicine, and it is absent from online consultations? Rynne, however, doesn’t see it that way. “This is much easier than face-to-face consultations. You give them the advice and support and they can take it or leave it. Also, both patient and doctor have much more time to think and reflect.”
In addition, Rynne says from the patient’s point of view it is much more affordable and easier for them to be fully honest about their worries. They can get a quick inexpensive opinion to see if they need to see a doctor in the first place with no waiting lists, no waiting rooms full of contagious diseases and no stress. “They can have it all from the comfort and safety of their own home.”
There are limits, of course, to online medicine, he admits. Doctors will always need to feel the lump, listen to the chest, take the blood pressure and draw the blood. “But there are things, and sexual dysfunction is one of them, that only require description – and here it can be a powerful tool. It can help people globally who might otherwise struggle to get any sort of help. There is a massive feel-good factor in all of this for the service provider.”
