DTAP Cares – Here For You, Here With You

The increase in social distancing and progressive lock down measures in Singapore and around the world during this COVID 19 season have prompted a big change in the way we care for our patients here at DTAP clinic.

The numbers around the world have been alarming as Spain and Italy have become the countries worst hit by the virus with over 6,000 deaths. The need to stay home and observe social distancing have slowed down the spread of COVID, not overwhelm the healthcare system and most importantly save lives.

At DTAP Clinic, we’ve made many numerous steady changes to our day to day operations to protect our staff and our patients.


This is what we have done at DTAP clinic 

  1. Screen everyone who makes an appointment or comes through our doors with the Ministry of Health’s criteria
  2. Check everyone’s temperature and symptoms of cough, respiratory illness
  3. See our patients on an appointment basis – this means NO OVERCROWDING, in the clinic and effective social distancing
  4. Increase frequencies of disinfecting the clinic and if a patient who saw us has any symptoms we thoroughly disinfect the clinic after the patient leaves. (Of course with the usual Personal Protective Equipment worn)

Where it is important to stay home, we are also cognizant that one can still get symptoms, need their medication refills and pick up other non covid diseases all the same.

Furthermore, the sellout of condoms around the world tells us that people staying home are resorting to millenial old, tried and tested forms of entertainment.

To further strengthen our support and commitment to our patients in these uncertain times, we have also thus done 3 more things to ensure our patients are fully cared for 


1. DTAP TELECONSULT SERVICE:

DTAP Teleconsult
In light of the COVID-19 situation, we are offering DTAP Teleconsult. This teleconsult service allows our current patients and new patients to connect with our doctors during clinic operating hours for non-emergency consults. After assesment and consultation, we will also deliver your medications straight to your doorstep. Learn more

That’s right, our very own teleconsult service where our DTAP clinic doctors address your health concerns as much as possible in the comforts of your own home!

If it is deemed that you need a blood, urine, swab test to further confirm your diagnosis, we would then schedule you at the next most convenient time slot, AWAY FROM OTHER PATIENTS.

And if our doctors deem that you should require medications, again you can get them via our delivery service or our pickup service, more details below.

And if our doctors deem that you should require medications, again you can get them via our delivery service or our pickup service, more details below.


2. DTAP Medication Delivery Service

DTAP DELIVERY
Getting your medication on time is important. As part of our initiative to provide better patient care to our patients, we are now providing delivery service to your doorstep – Anywhere in the Singapore mainland. Learn more

If you need a refill of your medication prescription, or need to get treatment after your tests, or even get new meds after our doctors have diagnosed you,

Have no fear, together with our partners we deliver to your doorstep the very next day. 

And of course all this is within the SS644 Singapore medication delivery guidelines, where the integrity of the medication, your personal data are fully respected and protected 

So from the comfort of your own homes, you can get the essential medications you need, or if you were planning a special night with your loved one, not be caught out without your trusty blue pill even.


3. DTAP Order & Pick Up

Last but not least, for those who live and work nearby our clinics and want to drop in quickly to pickup your repeat meds, or even new medications, getting your payment done online and the items prepared would allow you to skip the queue, skip the wait and in between your busy lunch hour or schedule, you can still get your errands done, all in a heartbeat.

Stay safe amidst the current situation and remember to look out for your family and loved ones!


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Sclerosing Lymphangitis

Sclerosing lymphangitis is a skin condition that manifests as a firm cord-like structure encircling the coronal sulcus, which is the circumference of the base of the penile head.

Sclerosing lymphangitis is observed usually in the second or third decade, although cases as young as 18, and as old as 66 years of age have been reported. The condition is thought to be fairly common, but significantly under-reported because it is usually asymptomatic and resolves spontaneously, therefore most patients do not visit a doctor.

Various other terms have been used for this condition, including non-venereal sclerosing lymphangitis of the penis, circular indurated lymphangitis of the penis, lymphangiosclerosis and sclerotic lymphangitis.


Causes

Sclerosing lymphangitis is thought to occur from prolonged or frequent vigorous sexual intercourse or masturbation. The resulting microtrauma leads to obstruction of a large lymphatic vessel. 

Signs and symptoms

Sclerosing lymphangitis presents as a skin coloured, serpiginous cord-like thickening encircling the coronal sulcus of the penis. It can feel like a hardened, almost calcified vein. There are no signs of inflammation, and the lesion is painless. It usually develops within a few days to a week after the sexual activity. 

Treatment

Sclerosing lymphangitis can cause anxiety and embarrassment due to its genital location, alarming appearance and association with sex. However, it is self-limiting and does not require treatment aside from reassurance and advice to restrain from vigorous sexual activity until the condition subsides. In most cases it resolves spontaneously after 2 to 3 weeks, but can last up to 6 weeks or longer. Investigations such as ultrasound scan or biopsy are not necessary. In recurring cases, surgery can be performed to excise the affected vessel.

Although the condition is by definition not associated with sexually transmitted infections (STIs), patients are advised to consider basic STI screening.

Next read: COMMON CAUSES OF BUMPS & WHITE SPOTS ON PENIS & FORESKIN


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Low Testosterone & Low Libido

Having low levels of testosterone or Testosterone Deficiency Syndrome is common and can occur in about 1 in every 200 men under the age of 60 and 1 in 10 men over the age of 60. Commonly the symptoms may be subtle and thus can be easily overlooked as “Oh, it’s just part of aging.”

As men age, levels of testosterone drop by about 1-1.5% each year after age of 30 but not all males experience the drop in levels. It is known from studies that the more overweight you are, the faster the decline in the levels of testosterone. In addition, it has been shown in studies that low testosterone levels are associated with cardiovascular risks like coronary arterial disease and metabolic syndrome including type 2 diabetes.


Effects of having low testosterone:

  • Regression of some features of male sexual characteristics
  • Low mood or irritability
  • Poor concentration
  • Low energy, feeling tired
  • Hot flushes and sweats
  • Decreased libido
  • Reduced beard or body hair growth
  • Low semen volume
  • Gynecomastia
  • Reduced muscle strength
  • Fracture (osteoporosis)
  • Erectile dysfunction

It has been shown in some studies that supplementation of testosterone in those with low testosterone levels can increase their libido. 


Causes of low testosterone

Generally the causes of low testosterone can be classified into testicular (Primary) and Hypothalomo-pituitary (Secondary) causes.

Primary

  • Age-Related Testosterone Deficiency
  • Chromosomal: Klinefelter syndrome – Congenital;
  • Undescended testes
  • Surgery: bilateral orchiectomy
  • Trauma
  • Infection: mumps orchitis
  • Radiotherapy/chemotherapy/drugs (spironolactone, ketoconazole)

Secondary

  • Idiopathic hypogonadotropic hypogonadism
  • Pituitary microadenoma (<1 cm) or macroadenoma (>1 cm)
    • Functional or non-functional: in men typically macroprolactinoma
  • Other causes of hypothalamic pituitary damage: surgery, radiotherapy, trauma, infiltrative disease such as haemochromatosis

Treatment options

Lifestyle modifications – diet and exercise

It has been shown in studies that resistance weight training can increase levels of testosterone. Reducing body fat has also been shown to increase levels of testosterone. There are some studies show high-intensity interval training (HIIT) is more effective in reducing body fat than steady-state cardio.

Medications: Testosterone Replacement

There are several formulations available for replacing testosterone. The choice of which formulation to use is largely patient preference.

  1. Slow releasing formulation injections – generally given every 10-12 weeks as an intramuscular injection. Some people prefer that as they only need to get 1 injection once every 3 months or so rather than to take medication daily.
  2. Short acting formulation injections – these injections are given once every 1 to 3 weeks. Most of the time, patients learn to inject themselves.
  3. Gels or capsules – generally capsules are taken twice daily and gels are applied once daily. Gels are preferred by some as it is only used once daily and also in some cases, those who used the injectable form experience swings in their symptoms especially when it approaches the time for the next dose. But as the gel is applied daily, the levels of testosterone remain relatively stable and thus avoid the swing. However, gels may not be suitable for a person with an active lifestyle as the testosterone in the gel may not have enough time to be absorbed before they commence their exercise or when they shower after the exercise.

Next read: 7 TESTOSTERONE BOOSTING FOODS THAT YOU CAN FIND IN THE SUPERMARKET

Watch next: HOW DO YOU INJECT CAVERJECT


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Circumcision Healing

Circumcision Healing

“I have been performing circumcision for men for many years now,” says Dr Taufiq, resident doctor, DTAP (Dr. Tan & Partners) clinic.

One of the common fears that is stopping or holding them back from going through the procedure is the fear of pain or complications during the recovery process. Let me reassure you with our current method, having complications or pain is much less than before. However, I have compiled a list of tips to help you to optimize your recovery based on my experience and my patients’ feedback.

Also read: HOW DOES SUTURELESS CIRCUMCISION​ TECHNIQUE (SHANG RING) WORK?


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1. Have adequate rest

Especially during the first few days up to a week after the procedure, it is best to have adequate rest to allow your body to focus on healing. I will usually provide medical leave for up to a week to ensure that you have adequate rest at home.

2. Avoid strenuous activities

I know some men may get restless or feel uncomfortable with lack of physical activity especially when they are used to exercising regularly. However, this is important as well to help with recovery and avoid complications like bleeding or swelling. I had a few patients who started brisk walking within a few days of procedure and ended up with swelling around the wound area. It is advised to avoid strenuous activity for 4 weeks. Normal day to day walking is allowed so don’t have to worry about this procedure affecting your daily activities. 

3. Keep it clean

After the procedure, with the ring still intact, you are allowed to shower as per normal. To keep the wound area clean, you just need to let the soap and water from your body to run down to the area. No need to specifically rub, apply soap and it. If there is an obvious liquid or residue on it you can wash it off with water. By keeping the area clean it helps to allow the wound to heal faster.

4. Keep it dry

After cleaning, the ring tends to retain water or moisture. It is advised to dry it properly before putting on your clothes. You can use a soft towel to dab dry or a hairdryer using normal temperature to dry the area. If the wound stays we may promote infection or increase serous discharge production. So make sure it is dry before you put on your pants.

5. Antibiotic powder

After the procedure, you will be prescribed antibiotic powder. This is very helpful to keep the wound dry and also prevent infection. Apply at least once to twice a day.

6. Sleep on your side

One of the common causes of discomfort after circumcision is erection. For men, erections occur naturally at night or early morning. So this sometimes causes discomfort. Sleeping on your side may help to reduce the frequency of erections at night while you’re sleeping thus minimizing discomfort.

7. Ice pack

Another effective way to minimize erections is by applying ice pack. You can standby an ice pack or a pack of frozen peas by your bedside. If in the case of an erection that is causing pain, you can apply the ice pack on your scrotum. The cold will help to reduce your erection. 

Take as soon as you start to feel discomfort.

Next read: WHAT ARE THE TOP 7 REASON MEN UNDERGO CIRCUMCISION

Next read: CIRCUMCISION REDUCES BACTERIA AND RISK OF STDS

For more information: HOW IS THE ADULT CIRCUMCISION (FORESKIN REMOVAL) PROCEDURE DONE?

Speak to your doctor if you have any questions regarding circumcision.


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Movember: Testicular Cancer

Testicular Cancer & Self-Examination

It is November this month, which is also the month of Movember! Movember is an annual event which to most people, involves the growing of moustaches and beards. But the true meaning behind Movember is to raise awareness of men’s health issues, such as prostate cancer, testicular cancer, and men’s suicide. 

In the same vein, today we will be talking more about testicular cancer and self-examination. Testicular cancer is the most common cancer in men aged 15 to 34 years.

The testicles are the sex organs located inside the scrotum. They produce the male sex hormones and sperm for reproduction. Testicular cancer is a cancer that arises from the cells that make up the testicle. Testicular cancer is comparatively rare when put side by side with other cancers, but testicular cancer is the most common cancer in males between the ages of 15 and 35.

Signs & Symptoms Of Testicular Cancer

  • A lump or enlargement of the testicle (cancer usually affects one testicle in most cases)
  • A feeling of discomfort, pain or heaviness in the testicle or scrotum
  • A dull ache in the lower abdomen or groin
  • Fluid in the scrotum
  • Groin lymph node swellings 
  • Breast swelling or tenderness

Know Your Risk!

Are you between 15-35 years old, of certain ethnicity, have an undescended testicle or a personal or family history of testicular cancer? Consider a testicular cancer screening.

The chances of a cure and full recovery increases when the cancer is detected EARLY.


The vast majority of testicular cancers are from germ cells (the cells that produce immature sperm). They can be either a seminoma or nonseminoma tumour. What causes germ cells to become abnormal and develop into cancer isn’t known, but factors that may increase your risk of testicular cancer include:

  • An undescended testicle
  • Personal history of testicular cancer (e.g. in other testicle)
  • Abnormal testicle development
  • Syndromes such as Klinefelter syndrome
  • Family history of testicular cancer
  • Being ages 15-35, however, testicular cancer can occur at any age too

However, many men with testicular cancer have no known risk factors

Cancer can also arise from the stromal (connective) tissues. These are often benign but sometimes can be malignant. These grow in the tissues that produce hormones inside the testicles. Testicular cancers can also be secondary (spread to the testicles from other organs), or lymphomas. 

Treatment For Testicular Cancer

Testicular cancer is highly treatable as they are very sensitive to chemotherapy, even when the cancer has spread outside of the testicle. Cure rates can reach as high as 90%-95%. However, patients cured of testicular cancer have about a 2% risk of developing a cancer in the contralateral testicle. 

If testicular cancer is found early when it is small and has not spread, the chances of a cure is much higher. Early testicular cancers may cause symptoms listed above that lead men to seek medical attention. The most common presenting symptom is a lump on the testicle. Having said that, testicular cancers in other people may not cause symptoms until the later stages.

There are doctors that recommend all men examine their testicles monthly after puberty, but because testicular self-exams have not been studied enough to know if they reduce the death rates from testicular cancer, no clear guidelines exist on whether or not they should be recommended to everyone. Each man has to decide for himself if he wants to examine himself. This might be more important if you have any of the risk factors listed above. Seek medical attention immediately if you do find a lump. Your doctor will advise as appropriate.

Testicular Self-Exam (TSE)

The testicles are easiest to examine when the skin of the scrotum is relaxed. The skin is usually relaxed when you are relaxed, or after a warm shower or bath. You can examine yourself lying down or standing up. Most doctors will examine you standing up. 

  1. Hold your penis away.
  2. Hold your testicle one at a time between your thumb and fingers.
  3. Roll it gently between your fingers.
  4. Feel for any lumps, bumps or fluid.
  5. If you do examine your testicles regularly, you will eventually know what is normal for you and what is different. Feel for any change in the size, shape, or consistency of your testicles. Seek medical attention if you notice any difference.

What’s Normal?

  • One testes may be slightly larger than the other
  • One side may hang lower than the other
  • Part of the testicle is known as the epididymis where sperm is stored. This may be felt as a bump at the posterior upper or posterior middle aspect of the testicles
  • Above the testicles you may feel a cord like structure – this is the spermatic cord where sperm is carried.

What’s Abnormal?

  • An abnormally large testes compared to the other side
  • A hard lump
  • Fluid around the testicle 
  • Dilated veins above the testicles which may feel like worms 
  • Tender lumps

Not all the above abnormalities are related to cancer. But if you do find such abnormalities, please visit your doctor for a consultation. One of the easiest ways to characterize a lump is with an ultrasound, which is completely painless.

Happy Movember everyone!

Speak To Our Male Doctor Today!

If you are experiencing any symptoms, or have any concerns or questions about prostate cancer and prostate cancer screening, please make an appointment with our clinics today or visit any of our Men’s Health Clinics or drop us an email at hello@dtapclinic.com for an appointment.

Circumcision Reduces Bacteria And Risk Of STDs

What is Circumcision?

Circumcision is a procedure where the excess foreskin is removed. This ritual has been performed on boys for thousands of years. It is currently practised by many faiths and culture. In the states, it is usually done within the first few days of life. Among Muslims and Jews, it is highly encouraged for boys to be circumcised. In fact, it is highly encouraged because it promotes better hygiene among other benefits. 

Male circumcision reduces the abundance of bacteria living on the penis and might help explain why circumcision offers men some protection against HIV, according to a study led by the Translational Genomics Research Institute (TGen).

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Are circumcised men less likely to contract HIV?

One of the most interesting benefits of circumcision is the finding that circumcised men are less likely to contract HIV, the virus that causes AIDS. In 2005, a study of South African men found that circumcised men who had sex with an HIV-positive woman were 63 percent less likely than uncircumcised men to contract the virus. Other than HIV, Circumcision has also been shown to reduce the risk of contracting HPV, or human papillomavirus. 

HPV is a virus that can cause cervical cancer in women. Another sexually transmitted virus is the herpes simplex virus type 2, better known as genital herpes. The risk of transmission of genital herpes is also reduced in men who were circumcised.


Bacteria and Sexually Transmitted Diseases (STDs)

Other than viruses, bacteria also are responsible for some of the common Sexually Transmitted Diseases (STDs). Circumcision has been proven to reduce incidence of Chlamydia Trachomatis infection. Interestingly, circumcision doesn’t just protect the men, but also protects the women as well.

In a study published in 2005 in American Journal of Epidemiology, there’s an 82% reduction of Chlamydia infection among women whose partners were circumcised as compared to women whose partners were uncircumcised.

A study of women in Kenya and Uganda enrolled in an RCT and followed up for 3 years found circumcision of their male partners was associated with a 59% reduction in incident syphilis among the women. A prospective study in Kenya by the same authors found that those with circumcised male partners had a 58% lower risk of incident Trachomatis vaginalis than did women with uncircumcised partners.

One of the main possible reasons behind lower risk of infection is the recent finding where there is a significant shift in the bacterial flora of the penis after circumcision. This was according to a study published by the online journal mBio. This international collaboration focused on 156 men in Rakai, Uganda — part of the world’s largest randomized-controlled trial on male circumcision.

Researchers showed that men who were circumcised as part of the study had 33.3 percent less bacteria on their penis than those who remained uncircumcised one year after the study began. Researchers further showed that the decrease was primarily found in 12 types of bacteria, most of which were intolerant to oxygen.

At the same time, understanding the mechanisms that underlie the benefits of male circumcision could help to identify new intervention strategies for decreasing HIV transmission, especially for populations with high HIV prevalence and in places where male circumcision is culturally less acceptable, the study says.

“We know that male circumcision can prevent HIV and other diseases in heterosexual men, but it is important to know why,” said Dr. Lance Price, the Director of TGen Center for Microbiomics and Human Health and the study’s senior author.

“We think that these dramatic changes in the penis microbiome may explain, at least in part, why male circumcision is protective, ” said Dr. Price, who is also a Professor of Environmental and Occupational Health in the School of Public Health and Health Services at the George Washington University.


HIV

In heterosexual transmission of HIV, the virus on the foreskin needs to reach its target cells, the CD4+ T-cells, which reside primarily in blood or the lymph nodes.

Researchers hypothesize that penis bacteria may facilitate this process in two ways: by both recruiting more HIV target cells to the foreskin and by triggering another set of immune cells, the Langerhans cells, to deliver the virus to susceptible T-cells. Without this trigger, the Langerhans cells will simply destroy the virus.

“Our findings are interesting from two perspectives. From a public health standpoint, we were finally able to detail the bacterial changes associated with male circumcision,” said Dr. Cindy Liu, Adjunct Professor at the Pathogen Genomics Division at TGen, and the study’s lead author.

“From an ecological perspective, our study shows how phenomena from the macro-world actually scale to the micro level. When you change a macro environment, such as clear cutting a forest, you affect the animals that live there. That’s intuitive. Here we show that changing the penis environment affects the microbes that live there as well.” said Dr. Liu, who also is a member of the Department of Pathology at the Johns Hopkins School of Medicine.


Currently circumcision among adults is carried out in Africa as a part of the campaign to fight HIV and AIDs. With increasing evidence of health benefits from circumcision, I am seeing more men coming forward to get circumcised voluntarily. These are men who have no medical problems that warrant a circumcision. They simply want to have better hygiene and reduce their risk of infection.

Also read: What Are The Top 7 Reason Men Undergo Circumcision?

At Dr Tan & Partners, we use the Shang Ring Method of circumcision. With this method, there is no need for injections and the procedure is very quick, simple and painless. Only numbing cream is used and after 30 minutes of application, the procedure can commence. The procedure itself takes only 10-15 minutes. Our patients are usually surprised at how painless and quick the procedure is. Most importantly they like how the results look at the end of the day.

Also read: How Does Sutureless Circumcision​ Technique (Shang Ring) Work

Next read: How Is The Adult Circumcision (Foreskin Removal) Procedure Done?

Speak to your doctor if you have any questions regarding circumcision.


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Rectal Douching and Associated Infection Risks

Similar to vaginal douching, rectal douching or anal douching is not something that many people talk about it polite circles. It is commonly practiced by Men-Who-Have-Sex-With-Men (MSM) who receive anal sex. Let’s face it, generally we don’t want our loved ones to have to deal with our faeces while having anal sex. However there is a growing concern about the practice of performing anal douching and its associated risk of STI including HIV infection.
Other Read: Anal Pap Smear for Anal Cancer.
 

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A recently published systematic review (essentially this means that the study involves gathering all published studies on a subject and compiling the findings together) in the journal Sexually Transmitted Infections (May 2019), there is evidence to suggest that anal douching can potentially increase the risk of STI and HIV infection among MSM. In the systematic review, it included a total of 28 studies looking at anal douching and the risk of STI/ HIV in MSM population around the world (46% from US, 35% from Europe and the rest from South America, Asia and Africa). 
Also Read: STD Risk From Receptive Unprotected Anal Sex In Men
 


The findings show that men who perform anal douching compared to those who don’t have a 2.8 times higher risk of HIV and close to 2.5 times higher risk of any other types of STIs (Hepatitis B, Hepatitis C, chlamydia, gonorrhoea, syphilis and HPV). With respect to specific STIs, the study found that anal douching increases the risk of chlamydia and gonorrhoea by up to 3.25 times and 3.29 times for Hepatitis B Virus and Hepatitis C Virus.
It is theorised that possible reasons for the association of anal douching with increased risk of STIs and HIV may be due to:

  1. Water and/ or soap causes the delicate lining of the rectum and intestines to become damaged.
  2. Removal of normal flora (bacteria that normally is found in the rectum) due to the action of flushing
  3. Risk of transmission of STIs and HIV through the sharing of douching devices much sharing of needles for IVDU. 

 


The authors also noted that further studies will be needed to further elucidate this association between anal douching and STIs and HIV infection.
Speak to your doctor if you have any questions regarding the associated infection risks from rectal douching or anal douching.
 


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Common Causes Of Bumps & White Spots On Penis & Foreskin

This situation may be familiar to many men: while taking a shower one day, you happen to notice some white spots on your foreskin. You do a double take as you lean down to inspect your manhood. What could it be? How long have they been there? The questions are aplenty as you instinctively reach for your smartphone to begin a Google search.

There are many conditions that can cause white spots to develop on the penis and foreskin. Some men may be born with them, while others may develop them as a result of poor hygiene practices or sexually transmitted infections (STIs). It is important to know what the white spots are due to, as not all conditions require treatment. Listed below are some common causes of white spots on the foreskin and penis.


Pearly Penile Papules

Pearly penile papules (PPP) are small, dome-shaped or projection-like bumps that are located just below the head of the penis, usually arranged in a neat row. They can be white, flesh-coloured, yellow or translucent in colour. They do not cause any pain or itch. PPP is considered as a normal variant of the male penile anatomy, and are harmless bumps. It is not cancerous and there is no cancer risk. It is not a sexually transmitted infection and is not contagious. It is common and can occur in up to 38% of young men up to age 25.

PPP can be left alone and does not require treatment. However, for men who find them unsightly, they can be removed. Treatment options include laser therapy, cryotherapy and electrosurgery. 

READ: What are Pearly Penile Papules?


Fordyce Spots

Also known as Fordyce glands, these are harmless, small white or yellow bumps that are found on the foreskin. They are basically enlarged sebaceous glands, and can occur alone or in clusters. They do not cause any pain or itch. Fordyce spots can also commonly occur on the edges of your lips or on the inside of your cheeks.

Just like PPP, Fordyce spots are not cancerous and infectious, and also does not require treatment. Similarly, they can be removed if men find them unsightly. Treatment options include topical retinoid cream, oral isotretinoin, laser therapy and electrosurgery. 


Tyson’s Glands

Also known as preputial glands, Tyson’s glands are modified sebaceous glands that are found on the inner surface of the foreskin. They occur in pairs and are located on either side of the frenulum. These glands are also present on the hood of the clitoris in females. Tyson’s glands are normal structures and do not require treatment.  


Skin Tags

Skin tags are small, soft, flesh-coloured growths on the skin. They usually have a stalk and hang off the skin, and can vary in size from a few millimetres up to several centimetres. They tend not to grow on the penis itself, but rather, around the groin and scrotum. They often grow in areas where the skin folds and rubs against itself, and as such they are often also found on the neck, armpits, eyelids and under the breast. They affect men and women equally. Obesity, diabetes and pregnancy can increase the chances of occurrence.

Skin tags are benign tumours of the skin and do not require treatment. Occasionally, they may fall off on their own. People often wish to get them removed for aesthetic reasons, or if the skin tags are large and get in the way. Treatment options include cryosurgery, electrosurgery, ligation and excision.  

READ: Skin


Balanitis

Balanitis is inflammation of the foreskin and head of the penis. Spots can appear on the penile head or foreskin, and can be white or reddish. Other symptoms include redness, pain, itching, discharge, swelling and difficulty with retraction of the foreskin, and sometimes pain when passing urine. 

Balanitis can affect as many as 1 in 10 males, and can occur at any age. It is more likely to occur in uncircumcised men. The most common cause of Balanitis is a bacteria or fungal infection, or a combination of both. This can result from inadequate personal hygiene and/or phimosis (tight foreskin). There are non-infectious causes for balanitis as well. Risk factors for recurrent balanitis include diabetes, HIV and other sexually transmitted infections. 

To investigate balanitis, your doctor may perform swab tests to identify the responsible organism. Treatment involves topical and/or oral anti-fungal and antibiotics. The long term solution to balanitis is a circumcision.

READ: Causes, symptoms and treatment of Balanitis.

Pimples

Pimples develop as a result of the pores of our skin being blocked by dead skin cells, sebum and other debris. The sebaceous gland continues to produce sebum and build up under the blockage, allowing bacteria to grow in the area, resulting in inflammation, infection and pain. They can occur anywhere on the body, including the penis.

Pimples can be left alone and usually resolve on their own without treatment. It is important to resist the urge to pop the pimples as this may lead to superimposed infection, scarring and hyperpigmentation. However, they may end up self erupting and discharge small amounts of pus. Treatments for pimples include topical over-the-counter creams such as benzoyl peroxide, antibiotic creams and, if more severe, oral antibiotics.

READ: Skin


Folliculitis

Folliculitis is an inflammation or infection of the hair follicles. It can occur anywhere on the body, including the penis, where it is frequently seen at the shaft or base of the penis, or the pubic area. Folliculitis tends to result from shaving, waxing or chafing of the hair follicles. The damage to the hair follicles allows bacteria to enter. Sometimes, ingrown hairs can also occur from hair removal treatments, eventually leading to folliculitis as well. Folliculitis can be painful and/or itchy. Treatment options include topical and/or oral antibiotics. 

READ: Common causes of penile itching and pubic itching


Genital Warts

Genital warts are caused by the Human Papillomavirus (HPV). HPV is the most common sexually transmitted infection and can be spread via vaginal, oral or anal sex. They appear as flesh-coloured growths over the genitals that can cluster and resemble a cauliflower. Most of the time they do not have any symptoms but can sometimes itch. Bleeding can also occur during sexual intercourse. 

READ: Causes, symptoms and treatment for Genital Warts
READ: How to get rid of Genital Warts

Left alone, the warts can remain the same or increase in size and number. They will disappear once the body has shed the virus completely, typically over a course of 1 to 2 years. Treatment options include topical medications such as imiquimod, cryotherapy and electrosurgery. Vaccines are available to help prevent HPV infection, consider getting a HPV vaccination. 

READ: HPV Vaccination For Men
READ: Rapid HPV Testing

Genital Herpes

Genital herpes is caused by the Herpes Simplex Virus (HSV) and is a sexually transmitted infection. Itching of the penis is usually the first symptom, and can occur in other areas such as the scrotum, groin, buttocks and anus. Shortly after, tiny clusters of painful blisters develop, which can then rupture and form shallow ulcers with crusts. Other symptoms include painful urination, enlarged groin lymph nodes, fever and body aches. The virus can lie dormant in the body for years without causing any symptoms, therefore some people may not even be aware that they are infected. 

Genital herpes can be diagnosed via swab testing of the lesions. When there are no symptoms, no treatment is required. Flares can be treated with oral and topical antiviral medications. There is unfortunately no cure for genital herpes, as the virus will permanently remain in the body.

READ: Rapid Herpes Testing

Molluscum Contagiosum

This is a benign infection of the skin caused by the Molluscum Contagiosum virus, resulting in painless, small, shiny pearl-shaped lesions. They can happen anywhere on the body as a result of physical contact, but when they occur on the genital area, it is usually as a result of sexual contact. The virus is thus spread via sexual contact, or even to another part of the person’s own body, from scratching the lesions and touching another part of the body. They can appear alone, or in clusters. They usually do not cause any symptoms, but can sometimes itch. 

Left alone, the lesions will eventually disappear once the body has shed the virus completely, typically over a course of several months to a year. Treatment options include topical medications such as salicylic acid, cryotherapy, laser therapy and curettage.

READ: Everything you need to know about Molluscum Contagiosum

In conclusion, do not panic if you notice white spots on your penis, as not all white spots require treatment.  Speak to your doctor for advice on white spots or bumps and request for an examination. 

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How to Perform Testicular Self Exam

There are doctors that recommend all men examine their testicles monthly after puberty, but because testicular self-exams have not been studied enough to know if they reduce the death rates from testicular cancer, no clear guidelines exist on whether or not they should be recommended to everyone.
Each man has to decide for himself if he wants to examine himself. This might be more important if you have any of the risk factors listed above. Seek medical attention immediately if you do find a lump. Your doctor will advise as appropriate.
Testicular cancer is comparatively rare when putting side by side with other cancers, but testicular cancer is the most common cancer in males between the ages of 15 and 35.

How to Perform Testicular Self-exam

Step 1: Clean up, Warm-up


(Testicular Self-exam)
The testicles are easiest to examine when the skin of the scrotum is relaxed. The skin is usually relaxed when you are relaxed, or after a warm shower or bath.

Step 2: Roll it Gently between Your Fingers


(Testicular Self-exam)
You can examine yourself lying down or standing up. Most doctors will examine your standing up.
Hold your penis away. Hold your testicle one at a time between your thumb and fingers. Roll it gently between your fingers.

Step 3: Feel for any Lumps, Bumps or Fluid


(Testicular Self-exam)
Check for any lumps, bumps or unusual features. If you do examine your testicles regularly, you will eventually know what is normal for you and what is different.

Step 4: Feel for any change in the Size, Shape, or Consistency


(Testicular Self-exam)
Feel for any change in the size, shape, or consistency of your testicles. Seek medical attention if you notice any difference.

What is normal

  • One testis may be slightly larger than the other
  • One side may hang lower than the other
  • Part of the testicle is known as the epididymis where sperm are stored. This may be felt as a bump at the posterior upper or posterior middle aspect of the testicles
  • Above the testicles you may feel a cord-like structure – this is the spermatic cord where sperm is carried.

What is abnormal

  • Abnormally large testes compared to the other side
  • A hard lump
  • Fluid around the testicle
  • Dilated veins above the testicles which may feel like worms
  • Tender lumps

Not all the above abnormalities are related to cancer. But if you do find such abnormalities, please visit your doctor for a consultation. One of the easiest ways to characterize a lump is with an ultrasound, which is completely painless.

Speak to our doctors for more information or professional advice on testicular cancer at our Men’s Health Clinic.

Happy Movember everyone!

Movember (Moustache + November)

Movember (Moustache + November) is a global movement by the Movember Foundation which puts the spotlight on men’s health, especially prostate cancer, testicular cancer, mental health and suicide prevention.
The Movember Foundation recognized that males of all ages may hide their pains and suffering and ultimately result in greater problems, including an untimely demise. Unlike females, males are unlikely to share their deeply personal pains and suffering with others, including loved ones or professionals. This is why it is important for fellow males to stand up for each other, and lift them up from the fog of suffering and silence.

Cancer and Suicide – Not a pretty picture

Prostate Cancer

Prostate cancer now makes up one in seven cancers in Singapore males and is the third most common cancer now. In the five years from 2011 to 2015, almost 20% of those diagnosed with prostate cancer died. What is worse is that prostate cancer in the early stages has no symptoms at all. The earlier the cancer is diagnosed, the more likely the treatment will be successful for patients and help them remain in remission.

Testicular Cancer

While testicular cancer only accounts for 1 to 2% of all cancers in males, it is the most common cancer in young males between ages 20 to 40 – at the prime of their lives. Like prostate cancer, the earlier testicular cancer is diagnosed, the more likely that a cure is achievable.
See:  How to Perform Testicular Self-Exam

Suicide Prevention

More than 70% of all suicides in Singapore for 2018 were males. This is not unique to Singapore. In Australia, males accounted for 75% of suicides. The number of male suicides in Singapore is twice that of women and the majority were aged 65 years old and above.
It is generally believed that many factors contributed to these statistics. Societal pressures for males to “Man Up” means that males may feel isolated and have nowhere to turn to for help.
In addition, many males may feel that if they seek the help they will lose status or identity and they fear that they may lose independence, competence, control, and autonomy, all of which are perceived norms expected of males.

Mental Health

Finally, a previous study by Oogachaga (a non-profit community-based organisation that works with LGBTQ individuals) in Singapore showed that 3 in 5 LGBT individuals who participated in the survey reported facing some form of discrimination as a result of their sexual orientation. This may be part of the reason why in 2015 a study in CDC found gay and bisexual youths in the U.S. are 4 times more likely to have attempted suicide than their straight peers.

What can you do?

Now, anyone, especially males, can step forward and support your buddies and families by:

  1. Growing a moustache or beard for the month of November.
  2. Pledge to walk 60 km for the month of November – for the 60 men that are lost every hour globally due to suicides.
  3. Spend time with your buddies – be it having a night out or playing a favourite sport or whatever activity you enjoy doing together.

For the whole month of November, Dr. Tan & Partners (DTAP) is proud to support the Movember 2019 initiative with a supportive and friendly environment throughout all its clinics for men of all ages to seek help for all men’s health issues.
Dr. Julian Ng

Dr Julian Ng has 10 years of medical practice experience. He currently serves as the Chief Medical Officer of the DTAP Group of clinics in Singapore, Malaysia and Vietnam. He is also a member of the Singapore Men’s Health Society. His special interests are in the field Andrology, especially sexual health. He is currently practising at Dr Tan and Partners (DTAP) clinic at Novena Medical Centre.