Mens health

Question 1

Why is men’s health so important?

Answer 1

• men don’t live as long
• mens use of health services and information is generally poor
• death rates from preventable causes are high
• 76% of suicides
• 73% of adults who go missing
• 78% of drug related deaths
• 5 x more likely to be diagnosed with adhd

Question 2

What is circumcision?

Answer 2

• Removal of foreskin from the end of the penis
• often for cultural or religious reasons
• commonly between birth and early 20s

Question 3

What are the advantages and disadvantages of circumcision?

Answer 3

+ Can reduce/treat recurrent balanitis (skin irritation at head of penis) and penile cancer and phimosis (foreskin is too tight so can’t retract behind the head of the penis)
+ thought to protect against HIV- not proven
- can cause infection
- can damage the penis
- can cause swelling for a short period- if more than 3 weeks, refer to GP

Question 4

What is male pattern baldness?

Answer 4

50% of men by age 50 experience hair thinning, receding hair linen due to hair follicles becoming sensitive to dihydrotestosterone (DHT)

Question 5

What is the treatment for male pattern baldness?

Answer 5

• Not any treatment but can use hair pieces/wigs or surgery to boost self esteem
• drug treatments: available OTC or private prescriptions (not available as NHS POM):
• Minoxodil- originally used in hypertension, now used for 70% increased hair growth
  costs £100 for a 6 month treatment and hair will disappear within 3-4 months of stopping treatment
• Finasteride- blocks conversion of testosterone to dihydrotestosterone
  causes new growth in 2/3 and stops loss in 1/3
• hair will reverse 6-12 months after stopping treatment
  needs continuous use for 4months-2 years treatment for full effect

Question 6

What is the role of the prostate gland?

Answer 6

• Storage and secretion of semen
• protects sperm

Question 7

What are some conditions associated with the prostate?

Answer 7

• Prostate cancer- Malignant growth in the prostate which increases likelihood with age
  often has slow progression and successful treatment
• Benign prostate hyperplasia- rare under 50 years old
  non-malignant increase in size of prostate with age
• Prostatitis- inflammation of the prostate

Question 8

What is the ‘IPSS’?

Answer 8

The International prostate symptom score
This is a questionnaire used to measure the severity and impact of enlarged prostate on an individual
- Patient has to assign a score from 0-5 depending on how often certain factors (e.g. bladder emptying, blood, urine frequency etc) are causing a problem
scores will determine treatment:
mild= 1-7
moderate= 8-19
severe= 20-35

Question 9

What is BPH?

Answer 9

Benign prostatic hyperplasia- this is an enlarged prostate that is not cancerous

Question 10

What questionnaire is used to assess severity of symptoms in benign prostatic hyperplasia?

Answer 10

The international prostate symptom score (IPSS)

Question 11

What is the course of action if someone has pain (dysuria- pain on urination) with benign prostatic hyperplasia?

Answer 11

referral- this is a red flag symptom as pain should not be a symptom of an enlarged prostate

Question 12

What are the symptoms of an enlarged prostate?

Answer 12

• struggling to start urination
• increased frequency of urination
• straining on urination
• start stop urination
• urinary incompetence

Question 13

Does having an enlarged prostate increase an individuals risk of prostate cancer?

Answer 13

No- having an enlarged prostate doesn’t increase this risk

Question 14

What is the treatment for an enlarged prostate?

Answer 14

• if mild, will just be given lifestyle advice
  less alcohol, fizzy drinks and caffeine
  regular exercise
  drinking less in the evening - avoid fluids 2 hours before bed, will reduce getting up overnight
  reduce artificial sweetener intake
  double voiding- waiting after peeing and trying again
• if moderate symptoms, may be given medication to reduce size of prostate and help to relax bladder
  e.g. 5-alpha-reductase inhibitors e.g. Finasteride- used to reduce prostate size if high IPSS score
  or alpha-blockers (react muscles in prostate/bladder to help pee) e.g. Tamsulosin (Flomax)
• if severe may be offered surgery

Question 15

What are the possible complications of untreated enlarged prostate/BPH?

Answer 15

• Acute urinary retention- the sudden inability to pass any urine at all. Symptoms can include not being able to pee, lower tummy pain, swelling of bladder
• Urinary tract infections
• bladder stones
• bladder damage
• kidney damage

Question 16

What can increase risk of erectile dysfunction?

Answer 16

• Smoking
• alcohol
• drugs e.g. antidepressants, antihypertensives, antipsychotics
• stress
• tiredness
• diabetes
• high blood pressure/cholesterol

Question 17

What is erectile dysfunction?

Answer 17

The inability to get an erection or maintain an erection long enough to have sex

Question 18

What lifestyle factors may help with erectile dysfunction?

Answer 18

• Increased exercise
• decreasing bmi/loosing weight/health diet
• smoking cessation
• decreased alcohol consumption
• reduce stress

Question 19

What are the treatment options for erectile dysfunction?

Answer 19

• Vacuum devices- a pump that causes blood flow to the penis to form an erection. lasts about 1/2 an hour
• injections e.g. caverject (Alprostadil) - causes vasodilation for sustained erection- should erect 5-20 minutes after injection and will last for 30-60 minutes
• Oral testosterone
• Phosphodiesterase type 5 inhibitors (PDE-5) which prevent the breakdown of cyclic guanosine monophosphate (cGMP) breakthrough treatment e.g. Sildenafil (viagra)

Question 20

What was so special about the development of sildenafil as opposed to other drugs?

Answer 20

• Needs sexual arrousal to cause an erection, won’t erect immediately like the previous drugs as the nitric oxide pathway isn’t stimulated
• good if the medication is taken and then the individual doesn’t have sex

Question 21

What is the method of action of sildenafil (Viagra)?

Answer 21

• Normally, sexual arrousal causes the release of Nitric oxide (NO) from endothelial cells
• NO acts as a vasodilator by increasing levels of CGMP in smooth muscle by stimulating guanylate cyclase to convert GTP to cGMP
• Cyclic GMP is normally hydrolysed to phosphodiesterase type 5
• However, sildenafil is a PDE-5 inhibitor so prevents this from occurring. This causes an increase of cGMP in smooth muscle
• the increase in cGMP activates protein kinase G which causes a decrease in intracellular Ca2+
• this leads to smooth muscle relaxation (vasodilation) which increases flow of blood to the penis and therefore causes a sustained erection

Question 22

How long before sex does viagra/sildenafil need to be taken and what is the duration of action?

Answer 22

usual dose is 50mg taken when needed, up to 4 hours before sex- usually takes 30-60 minutes to work

Question 23

Aside from erectile dysfunction, what else is sildenafil used for?

Answer 23

Pulmonary hypotension

Question 24

What is priapism?

Answer 24

A prolonged and painful erection- an erection over 2 hours is classed as a medical emergency and should see a health care professional to avoid permanent damage to the penis