Mens health Flashcards
Why is men’s health so important?
- 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
What is circumcision?
- Removal of foreskin from the end of the penis
- often for cultural or religious reasons
- commonly between birth and early 20s
What are the advantages and disadvantages of circumcision?
+ 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
What is male pattern baldness?
50% of men by age 50 experience hair thinning, receding hair linen due to hair follicles becoming sensitive to dihydrotestosterone (DHT)
What is the treatment for male pattern baldness?
- 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
What is the role of the prostate gland?
- Storage and secretion of semen
- protects sperm
What are some conditions associated with the prostate?
- 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
What is the ‘IPSS’?
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
What is BPH?
Benign prostatic hyperplasia- this is an enlarged prostate that is not cancerous
What questionnaire is used to assess severity of symptoms in benign prostatic hyperplasia?
The international prostate symptom score (IPSS)
What is the course of action if someone has pain (dysuria- pain on urination) with benign prostatic hyperplasia?
referral- this is a red flag symptom as pain should not be a symptom of an enlarged prostate
What are the symptoms of an enlarged prostate?
- struggling to start urination
- increased frequency of urination
- straining on urination
- start stop urination
- urinary incompetence
Does having an enlarged prostate increase an individuals risk of prostate cancer?
No- having an enlarged prostate doesn’t increase this risk
What is the treatment for an enlarged prostate?
- 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
What are the possible complications of untreated enlarged prostate/BPH?
- 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
What can increase risk of erectile dysfunction?
- Smoking
- alcohol
- drugs e.g. antidepressants, antihypertensives, antipsychotics
- stress
- tiredness
- diabetes
- high blood pressure/cholesterol
What is erectile dysfunction?
The inability to get an erection or maintain an erection long enough to have sex
What lifestyle factors may help with erectile dysfunction?
- Increased exercise
- decreasing bmi/loosing weight/health diet
- smoking cessation
- decreased alcohol consumption
- reduce stress
What are the treatment options for erectile dysfunction?
- 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)
What was so special about the development of sildenafil as opposed to other drugs?
- 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
What is the method of action of sildenafil (Viagra)?
- 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
How long before sex does viagra/sildenafil need to be taken and what is the duration of action?
usual dose is 50mg taken when needed, up to 4 hours before sex- usually takes 30-60 minutes to work
Aside from erectile dysfunction, what else is sildenafil used for?
Pulmonary hypotension
What is priapism?
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
