H Ahmad, M Jalilallah, M Al-Rashedy
H Ahmad, M Jalilallah, M Al-Rashedy. Pilonidal Sinus And Prolonged Sexual Stimulation: The Poisonous Hormones. The Internet Journal of Surgery. 2005 Volume 8 Number 1.
Pilonidal Sinus PNS affects young people presenting as chronic sinuses and more frequently as acute abscess. Even after excision of the sinus a number of patients will have recurrence and need a second operation.
The problem is caused by a prolonged and sustained presence of high level of sex hormones in the circulation (androgen) causing continuous stimulation of a special sweat glands at the buttock area, the excess sweat produced contain a positively charged electrolytes which attract the negatively charged hairs (by friction) to dive in to the widely opened orifices of these glands resulting in their acute inflammation and chronic sinus formation on the long term.
If the circulating androgen level is reduced, the excess sweat secretion come to normal, the opened orifices of the sweat glands close, and the whole process of inflammation and abscess formation come to an end.
Evidence available suggests that some of the tubular glands are controlled by hormones, in rabbit all three apocrine glands are stimulated by androgen, the human apocrine glands of the axillary and pubic region are similarly under androgen control (1).
In men sexual stimulation by visual, auditory and olfactory pathways through the hypothalamus- pituitary- testicular axis act to increase sexual desire by elevating the circulating androgen level (2) which have an effect on the sex organs in particular and on the body as a whole including the sweat glands (resulting in their stimulation and increased secretion). There are special sweat glands at the buttock (Sudoreferous glands), such glands being more active in early manhood, these glands in some animals secret odoureferous substances during rutting season to attract opposite sex (4). These glands are under androgen stimulation and when the circulating androgen level is high the secretion of these glands increases, resulting in excess sweating in the buttock area. This sweat contain excess electrolytes, the composition of sweat varies greatly from person to person, time and site. The sweat is hypo tonic, the most important constituents of the sweat are Na, K (positively charged),& Cl, also urea & lactose (1).
The broken hairs in the cleft will have a negative charge by friction, which will be attracted by the positively charged sweat electrolytes to dive in to the open orifice of the sweat glands to start the process of inflammation and abscess formation.
The holes or pits seen at the buttock represent a distorted hair follicles and sweat glands openings that have enlarged under the continuous and prolonged stimulation effect of the high level circulating androgen. These enlarged hair follicles and sweat glands open mouths or pits appear first then the ingested hairs is secondary invader that start the process of acute inflammation and on the long term prolong the disease and interfere with healing, no hair follicle have ever been found in the sinus tract, this observation provided an early clue that hair found therein was of extraneous origin (2).. The way these broken hairs seen packed in to these tiny pits can not be explained but by this electric attraction mechanism.
Two groups of patients were studied
The first group
A retrospective review of files of patients with PNS treated by a colleague general surgeon (Dr Jalil), since his arrival at the hospital up to the start of the second group which is over a year now, when we started looking at a new way of treating patients with PNS.
There were 23 patients with mean age of 19.7 years
20 males, 18 single 2 married
3 females 2 single 1 married
M/F ratio: 6.6/1
86.9% single, 13% married
All these patients needed surgical excision of the chronic sinus after failure of conservative treatment; we did not include four patients presented with PNS abscess, as we did not consider them as chronic cases. They responded to I&D only. Two of the 20 males had a previous excision at the same site (recurrence).
The second group
There were 21 patients
20 males 16 single 4 married
1 female married
Mean age 22.6 years 80% single, 20% married
M/F ratio; 20:1
All patients advised about the cause of their problem and told how to avoid it. This is discussed in detail making sure each patient understood the idea behind this study and answering all their questions, and then we followed a simple clear protocol:
All loose hairs in the orifices of the sweat glands removed.
Antibiotic given if there are signs of inflammation (after swab taken for culture and sensitivity).
The patient was told clearly that the cause of his/her problem is a prolonged and sustained stimulation of these special sweat glands at the buttock by the high and sustained level of the circulating sex hormones as mentioned above, and if he/she avoid this prolonged stimulation and reduced the level of these hormones to normal the whole problem end, he/she will be free, and no more treatment is needed, if the instructions are followed and implemented.
The following advise points are helpful measures to help patients reduce the level of these sex hormones in their body:
Avoid visual stimulation by looking to other sex or sexually attractive sites and to avoid watching sex stimulating sites & movies.
If for any reason he or she sexually stimulated, should get rid of that by having a shower as soon as possible and not to leave it too long to minimize the damaging effect of these hormones on the body as a whole and to minimize the effect of these hormones on the buttock sweat glands. (The shower or a bath seems to clean out the effect of these hormones out of the body and break their circle, we do not know why, but in practice it has a proven effect).
16 of the 21 had excellent results. It mean they were cured and needed no surgical treatment following the above protocol.
2 of the 21 we could not see them, they told us over the phone they are doing well and we classified them as good.
3 had failed to improve and we returned them to the general surgeon for further treatment (surgical excision).
The % of success is 76.1% excellent, 9.5% good, 14.2% failed
One of those failed had multiple fistulae that refuse to heal; we think this is the cause that he did not get better. The second was looking too aggressive as far as his sexual desire concerned which mean the level of these sex hormone remained high and continued to stimulate these buttock glands. And the third was unable to understand the idea behind the advice we gave him, all those fail to respond are single males.
The married men and women were as follow (whom we were not expecting them to suffer from this problem, because they are married, and they suppose to have low level of circulating hormones)
A man 32 years married for few years was watching sex movies in his bedroom, which we think was stimulating his sexual hormones to high level and resulting him having PNS. He also gave history of PNS when he was single.
The second married man, his wife was pregnant and was unable to have sex because of her pregnancy was threatened. He came four weeks after her delivery when he reached his peak of waiting complaining from PNS. Also he went to Spain alone for two weeks, on his way back he felt pain at the buttock and came with PNS, were I removed a tuft of hairs from the opening of a sweat gland, and he needed no more treatment.
The third was a young woman of 20 years of age married, her husband working in Saudi and she was a university student studying in another country, she usually stay there nearly the whole academic year after she came to Saudi became ok the inflammation settled and needed no more treatment.
The fourth married man as we said before he seemed unable to understand the idea what we were talking about.
It is clear from looking at these married patients that they are practically singles, with high sexual desire leading to high circulating androgen in their circulation, which results in producing its effect on the body as a whole and on these buttock glands on particular, with the expected result.
PNS affect young sexually active or hyperactive people overwhelmingly single males, married people are affected whom either separated or usually having difficulty in their sexual life resulting in an increase in their circulating sex hormones which is the cause of the damage, the longer these hormones stays circulating in high concentration in the body the wider the damage they cause.
In our study we achieved nearly 86% of excellent/ good result with conservative treatment simply by educating patients about the cause of their disease and advising them how to avoid it. And now more than two years and all the patients in our group are doing well, no one came to need any further treatment. This proves that this theory of hormonal cause has a base.
The effect of these hormones has been looked at for long time by us and we think they are behind many of the known diseases affecting peoples in these days, as an example the following pathological processes are related to same cause of high hormonal level as Carpel tunnel syndrome, many infection as hair follicles infection and ACNE, perianal abscess and fistulae, deep veins thrombosis is another example, in fact a very good example of the effect of these hormones on the body as a whole and on the venous system in particular, were these hormones cause dilatation of the peripheral veins, slow the heart beats, and probably affect platelets aggregation, so they in fact complete the well known Verchow's tried which we all know, we have no doubt now that this hormonal cause is behind DVT and many other CVS pathophysiology as atherosclerosis, and the well known Economy class syndrome which we all know is firmly caused by the effect of these hormones. In fact many others diseases which we mentioned in an article written many years ago on an internet site prove that these hormones if they stay circulating at high level in the circulation are poisonous to the body and can cause a lot of side effect in way of diseases affecting this body.
This study shows that women are less likely affected than men, as their threshold of sexual stimulation is higher than men, some of the men have a very low threshold, Which is simply can be triggered by looking at the passing women on the road.
We do not know why having a shower or bath clear the effects of these hormones or reduce it. As if it cleans them out of the body, it is similar to the effect of water purred on a fire, this is proved in practice; it need more work to find out why and how.
This is also shows that for the first time in modern medicine that a disease is caused by the person behavior and his daily activities which has been ignored for long time, it is the time to look at the effect of these hormones on the body. The list of diseases caused is very long and we hope to finish working on some of those soon.
Increased level of circulating sex hormones in the body are poisonous and their presence in the circulation at high level must be kept for the shortest possible time, to do their specialized job and then be cleared off to avoid their wide spread damage to the body. The list of diseases which we think caused by the prolong effect of these hormones is long. PNS is one of these diseases caused by the increased and prolonged presence of these hormones in the circulation, if the patients understand the cause of the disease, then they can avoid it and help himself to get rid of it, they need not to get affected by this inflammation and need no treatment of any kind and no surgical intervention will be needed.
Dr. Hussain M Ahmad King Fahad Specialist Hospital Al qaseem , Buridah SAUDI ARABIA Tel: 966-6 3253736 Email: firstname.lastname@example.org