Managing men’s health issues

Men’s health refers to health issues specific to human male anatomy. These often relate to structures such as male genitals, and conditions related to or caused by male hormone (testosterone).

When providing health care to a man, a doctor always has it in mind that beyond curing a man’s illness is the improvement of the quality of his life.

Men’s health has become a major public health issue because of the challenges associated with their health which include the lack of awareness and understanding of the health issues they face.

Men don’t openly discuss their health and how they are feeling. They are reluctant to take action when they don’t feel physically or mentally well. They can engage in risky activities that threaten their health, and they usually don’t carry their partners along.

Worse still is the fact that stigma surrounds men’s health, which is also a challenge in itself.

Ten common men’s health issues seen in daily clinical practice include erectile dysfunction, low sperm count, zero sperm count, hernia, urethritis, epididymoorchitis, prostatitis, male menopause, benign prostate enlargement (BPH) and prostate cancer.

Others are premature ejaculations, testicular torsion, and undescended testes.

A patient of mine who was on honeymoon had told his wife a few days after their wedding that he had to get to the bank, only for him to be in the hospital to complain about inability to have erection!

He got married about five days before coming to the hospital. He said the wife saw her menstrual period on their wedding night and that seeing the blood had affected him such that he could not have an erection. He said the situation persisted till after the wife’s menstrual flow ceased on the third day. This is a case of erectile dysfunction.

He was confused and came for consultation. He was counselled, treated and was asked to come for follow-up. He was helped with medications.

However, he refused to show up for further monitoring; and when the hospital staff called to remind him of his appointment, he told them that the drug he was given was effective and that he would not be honouring the follow-up appointment.

Another patient had said a friend told him that erectile problems during honeymoons were spiritual and that he did not need medical intervention.

Greater percentage of men may be helped via medications, even while there is no harm for tackling the problems spiritually via prayers, counselling and support.

Erectile dysfunction (ED), commonly called impotence, is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It often causes serious distress, prompting men to seek medical attention they may not otherwise seek.

Erectile dysfunction is the most common sexual problem in men. The incidence increases with age and affects up to one third of men throughout their lives.

It causes a substantial negative impact on intimate relationships, quality of life, and self-esteem. History and physical examination may be sufficient to make a diagnosis of ED in most cases, while few may require test.

However, problems affecting men’s health extend far beyond erectile dysfunction and other commonly recognised men’s illnesses.

A couple who was receiving treatment for infertility had come for review of their result at the hospital. The nurse, on dropping the card on the doctor’s table, told the doctor that the man requested that his wife must not know the outcome of the sperm count. The nurse then left the consulting room.

The doctor stood up to welcome the couple, but the wife was already at the door with the husband. The doctor had asked the wife if she wouldn’t mind if he disclosed the result to the husband alone. The wife objected. She said they were in the clinic together to know the outcome of the result. The doctor held the result, fidgeting. The wife was already asking what the sperm count result and motility were, and whether the result was good or bad.

The doctor tried to be diplomatic by telling them it was not too good. The woman had asked again about what was not good there. The young doctor had told them to see the medical director the following morning to allow for more time for explanation and counselling. The truth is that the man had a zero sperm count but did not want it disclosed to the wife!

About one in 10 men will have an abnormal result on the first sperm (semen) test, but this does not always mean they have a ‘true’ abnormality. So, if the results of the first semen test are abnormal, the test should be repeated.

Ideally, this repeat test should be done three months after the first, but if it looks as though the sperm count is very low or no sperm at all, it should be repeated as soon as possible.

The import of this piece is to increase the need for men to seek medical care, especially in health issues that are specific to men and also to carry their partners along because some forms of therapies may directly or indirectly come from the woman.

The young man told me that he had ED, He had gone to a doctor who requested for several tests but due to the high cost of the test he went to a drug store. In the drug store he was shown a machine, a computer scanner.

He placed his thumb on the scanner and he was told the computer concluded he had a low sperm count.

 He had a prescriptions of testosterone, human menopausal gonadotropin (HMG) ,Ofloxacin and sildenafil citrate.

I had told him to go back to his doctor that all the drugs from the drug store are special drugs, that some may be harmful on the long term and may be associated with irreversible side effects like prostate cancer.

I had written in the last piece that whenever managing men’s health issues, a doctor always has it in mind that beyond curing a man’s illness is the improvement of the quality of his life and not harming the person involved.

Men with ED should be considered for a general medical checks including cardiovascular risk screening because studies have shown that men with ED have a significantly greater likelihood of having angina, myocardial infarction, stroke, transient ischemic attack, congestive heart failure, or cardiac arrhythmia compared with men without ED.

Men with ED also have a 75 percent increased risk of peripheral vascular disease.

Because most men are asymptomatic before an acute coronary syndrome, ED may serve as a pointer for discussions on promotion of cardiovascular risk factors and modification.

Risk Factors

Obesity nearly doubles the risk of ED

The risk of moderate or total ED is almost double in men who smoke compared with nonsmokers

Prevention

Patient education should be aimed at increasing exercise, losing weight to achieve a body mass index (BMI) less than 30 kg per m², and stopping smoking.

Treatment

When there is no obvious medical etiology for ED, psychosocial factors should be explored.

The potential clue that psychosocial factors may be a cause is that a man is able to achieve normal erections and orgasm through masturbation or sex with a partner other than the “index case” partner with whom he has erectile dysfunction (e.g., a spouse with whom there is substantial conflict).

Psychosexual therapy aimed at improving relationship difficulties may help to improve sexual dysfunction in men.

 Psychosexual therapy plus medications had more successful outcomes.

Some whose erectile dysfunctions are due to uncontrolled Diabetes mellitus ,uncontrolled high blood pressure may get out of ED by having these conditions controlled.

Some whose ED are due to effects of certain drugs should have those drugs reviewed by their doctors.

In some cases, education about medical and psychosocial etiologies of ED in conjunction with physician reassurance/counseling may prove adequate to restore normal male sexual function.

If a man is experiencing signs and symptoms that might be the result of a low testosterone level that include: Fatigue, Weakness, Depression, Sexual problems, it is good to consult a doctor. He or she can evaluate possible causes for the way you feel and explain treatment options.
In conclusion, the other men’s condition like Benign Prostrate Hypertrophy (BPH) and prostrate cancer causes a variety of "gentlemen's problems", chief among which is difficulty in urinating or the need to urinate frequently and constipation.
 Whether the prostate is growing benignly or malignantly, a test for prostate specific antigen in the blood - the PSA test - can reveal much about the health of this organ.

A manual examination by a doctor can be helpful too, of course, although less likely to be attractive to the patient.

I intend to write on Benign Prostrate Hypertrophy (BPH) and prostrate cancer in the month of April. Plan is also on the way to do a prostrate screening for men over 45 in conjunction with an NGO.

........concluded.