June 2021

JUNE IS MEN’S HEALTH AWARENESS MONTH 🎈🎈

There are several interesting medical topics for the month of June, however we will discuss Men’s health, concentrating on conditions that affect men’s genital system. These conditions are Benign Prostatic Hyperplasia (BPH), Prostate Cancer (CaP) and Erectile Dysfunction (ED).

Benign Prostatic Hyperplasia (BPH)
This is enlargement of the prostate which is located just below the bladder. When the prostrate enlarges, it causes interference with the flow of urine. BPH is noncancerous, and is quite common in older men, and by the age of 60yrs, 50% of men have BPH resulting in urinary symptoms. These include nocturia (waking up more than 2x at night to urinate), incontinence, weak stream, hesitancy (difficulty starting and maintaining flow), incomplete emptying, and frequent urinary tract infections.  Rarely, there may be – urinary retention, bladder stones, blood in the urine, kidney infection or kidney failure.

BPH Treatment: Medicines and Surgery
In mild cases, when one’s quality of life is not affected, a “watchful waiting” approach is used, and this entails regular visits to your doctor for review. Life style changes recommended include: restricting fluids at night, timed voiding (e.g. every 2-3 hours), decreasing caffeine intake, and double voiding (urinate, relax for some seconds and then do so again). For moderate and severe cases, medications, laser and different surgeries are available. Whichever method is used, they all have side effects, so discuss these with your urologist or doctor.

Prostate Cancer
This is one of the commonest cancers occurring in men, and the risk factors for developing it include: age, being of African/black ancestry, family history, and genetic changes. Other factors like smoking or diet are not as clear cut. Symptoms include, weak flow, urgency, nocturia, pain or burning with urination, and trouble emptying the bladder. However most will present with NO SYMPTOMS but have high PSA on a blood test. The type of cancer determines whether it is treated or not based on the “Gleason score”; this is calculated from the prostate biopsy and the level of the PSA blood test. The non-aggressive ones may not be actively treated but managed with active surveillance by a Urologist. This entails frequent blood work and other studies. The aggressive ones with a high Gleason score and high PSA may be treated with Surgery, Radiation, Chemotherapy, Hormone Therapy, Immunotherapy or a combination of these. A meaningful discussion between patient and urologist is needed before treatment choice. Seeking a second opinion with another urologist is also a choice one can make.

Erectile Dysfunction (ED)
ED or male impotence is a man’s inability to achieve an erection or maintain one firm enough for sex. It affects about 50% of men aged 40 years and above, and it can have psychological effects on the man, his self-esteem, and the relationship with his sexual partner. The causes of ED can be medical and psychological, with younger men mostly having the latter. Medical conditions include history of diabetes, hypertension, high cholesterol, prostate surgery damage to nerves or blood vessels and clogged blood vessels from vascular diseases. Medications including herbal ones may also be a cause. After a physical exam, medication review, blood work, urine tests, ultrasound of blood flow to the penis, and psychological testing for depression and anxiety may be done to see if a cause can be found. It is often said that ED maybe a sign of clogged arteries which can manifest as cardiovascular disease down the road, and so risk factors like Diabetes, tobacco abuse, Hypertension and high Cholesterol have to be controlled.

ED Treatment: Medication, Devices and Injections

MEDICATION
There are several medications which may help get a sustained erection for sex in many men. Examples are Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra). They increase blood flow to the penis and are taken about 15 to 60 minutes before sex.  Cialis’s effectiveness lasts the longest; up to 36 hours, and Viagra and Levitra last about 5 hours. Those who have heart disease and take Nitrates or are taking Alpha blocker medicines should not take the two close to each other since the combination can result in sharp decrease in Blood Pressure (hypotension).   For men with combined BPH and ED, one may be prescribed low dose Cialis to take every day, with a higher dose for sex, if needed, but that is determined by your doctor. Sexual stimulation is needed for them to work, so adequate foreplay is important. Viagra and Levitra should not be taken soon after a meal, because that affects their absorption from the stomach. Common side effects include mild headaches, vision changes (flashes of blue lights), nasal congestion. A prolonged erection is rare but may occur in those with Sickle Cell Disease. This is a medical emergency, requiring hospital treatment.

DEVICES and INJECTIONS
A vacuum pump device is placed around the penis to produce a vacuum which leads to increased blood flow to the penis. Other devices are Penile implants which are placed inside the penis surgically and have to be pumped up in order to produce an erection.

This article should be read by both men and women so that there is a better understanding of these conditions by all. Men should not be embarrassed about the above because they are common conditions and many unfortunately suffer in silence instead of getting help. Treatment is possible, do not be shy, talk to your doctor and receive help. Share with others👍🏾👍🏾

Thank You.
Dr. Barbara Entsuah  (Family Medicine Specialist and Author)

#Loveyourbody ❤️