Men's Health

Question 1

Symptoms of erectile dysfunction

Answer 1

Inability to achieve or maintain an erection so satisfactory intercourse may occur

Question 2

Causes of ED

Answer 2

• Vascular causes
• Neurogenic causes
• Psychogenic causes (emotional/mental conflict)
• Prescribed medicines
• Diabetes
• Smoking
• Alcohol
• Cycling (no evidence)

Question 3

Management of ED

Answer 3

• Non pharmacological management: Lose weight, stop smoking, reduce alcohol consumption, increase exercise
• Pharmacological Treatment: Viagra/Sildenafil or Tadalafil or Vardenafil

Question 4

Symptoms of premature ejaculation

Answer 4

• Men ejaculate too quickly during intercourse
• Majority of men develop this problem as they age
• Less likely to be a lifelong problem (some men do suffer PE for life

Question 5

Causes of PE

Answer 5

• Stress
• Relationship problems
• Anxiety
• Depression
• Medical conditions (diabetes, prostate conditions, thyroid condition)

Question 6

Treatment of PE

Answer 6

• Therapy, couples therapy - develop techniques to delay ejaculation
• Dapoxetine (Priligy) - SSRI licensed for PE use. Taken on demand between 1-3 hrs before sex
• Condoms containing low strength local anaesthetic agents in lubricant

Question 7

Early Symptoms of Testicular Cancer

Answer 7

• Enlarged scrotum
• Painful scrotal fulness (heaviness)
• Gynaecomastia - increased breast tissue gland (rare)
• Presence of a mass within the scotum -> any lump or bump

Question 8

Late symptoms of testicular cancer

Answer 8

• Cough
• Dyspnoea (obstructed breathing/shortness of breath)
• Coughing up blood (haemoptysis)
  -Abdominal mass
• Back pain
  These indicate metastases (cancer travelling to different parts of body - not good)

Question 9

What to recommend to identify early symptoms of testicular cancer

Answer 9

• Men should examine themselves once a month to be familiar with size, shape and texture of testicles
• Aim of examination is to identify changes or anything that feels unusual

Question 10

What are the symptoms of benign prostatic hyperplasia (BPH)?

Answer 10

• Enlarged prostate (causes bladder sensitivity + urgency)
• Increased frequency of urination due to increased bladder sensitivity and decreased volume
• Sensation of not completely emptying the bladder
• Double voiding - peeing straight after just peeing
• Acute urinary retention -> results in dribbling after pee
• Stop/stop urination
• Weak urine stream
• Nocturia
• Urgency
• Painful urination
• Haemorrhoids, hernia -> due to straining or prostate pressing on other parts of the vasculature

Question 11

What can failure to treat symptoms of BPH lead to?

Answer 11

• Infection/Cystitis due to bacterial growth in pooled urine
• Acute urinary retention (not expelling urine from bladder)
• Mimics prostate cancer

Question 12

Which OTC products make BPH symptoms worse?

Answer 12

• Sedating antihistamines, travel sickness tablets (has anticholinergic effects)
• Sympathomimetics

Question 13

Main Treatment of BPH

Answer 13

• 5-alpha reductase inhibitors: Finasteride, Dutasteride
• Used in men with large prostate glands
• Several months before benefits are seen
• Condoms should be used if partner is of childbearing potential as drug is excreted in semen
  REFERRAL

Question 14

Symptoms of prostate cancer

Answer 14

• Presenting symptoms may be similar to BPH
• Possible blood in urine or semen
• Possibility of severe backache
• May undergo metastases

Question 15

How to distinguish between benign prostatic hyperplasia and prostate cancer

Answer 15

• Digital rectal examination can help detect
• Prostate Specific Antigen PSA -> Best bio-marker for prostate cancer