Penile Discharge – Video

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Penile discharge

Penile discharge is any substance (other than urine) that comes from the urinary tube, also known as the urethra.

Normal discharge includes pre-ejaculate, or pre-cum, and semen ejaculate. These are usually produced during sexual stimulation.

Abnormal discharge can range from clear to pus-like and usually produced in the presence of an infection. In males, the infection is usually due to a sexually transmitted infection.

This may be accompanied by symptoms such as pain on the passing of urine, ulcers, urinary frequency and urgency.

The most common 2 causatives STI organisms are Chlamydia and Gonorrhea, but there are a variety of other microorganisms that can cause similar symptoms. Read more: STD symtopms

Non-STI organisms that cause urinary tract infections can also present with discharge. These are usually accompanied by urinary frequency, urinary urgency and foul-smelling or cloudy urine.

Similar organisms may infect the prostate causing prostatitis which may present with discharge, fever, urinary symptoms, pelvic pain and even blood in the semen.

If there has been any instrumentation of the urethra, for example with a catheter or after a procedure at the urologist, a discharge may also be produced due to the trauma.

Balanitis

Balanitis is inflammation of the foreskin and head of the penis that can cause some discharge under the foreskin. It may present with a rash, itching or pain, a foul smell and ulcers. The inflammation may be due to infections or irritation. While it is not a true penile discharge as it does not come out of the urethra, it may be confused with true penile discharge by some people.

If you do not clean your foreskin and head of the penis regularly, a layer of dead cells and sebum may build up. This is known as smegma and may also be confused with true penile discharge. While this is not harmful, it is advised to wash this area properly so smegma does not build up as a dirty head of the penis predisposes you to balanitis.

If you do have any of the symptoms that we have mentioned, please visit us at DTAP clinic so we can evaluate your condition.

 
 
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Penile Piercings

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Common types of penile piercings.

Penile piercing is a general term and there are actually many different ways and styles a man can get a piercing on his manhood.

Apadravya: This is a piercing that passes through the glans vertically. It can go from top to bottom or vice versa.

Ampallang: This piercing goes through the glans horizontally. It can go from left to right or vice versa.

Deep shaft: This piercing goes through the penile shaft. It can be pierced like Apadravya or Ampallang and goes through the shaft.

Dydoe/king’s crown: This piercing passes through the ridge or corona of the glans and on to the head of the penis itself. It usually comes in pairs.

Foreskin: This piercing is done through the foreskin of an uncircumcised penis. It is equivalent to a clitoral hood piercing in females.

Frenum: Frenulum is the skin that attaches the foreskin to the head of the penis. A frenum piercing is one that goes through the frenulum horizontally.

Guiche (perineum): This piercing is on the perineum. Perineum is the area between the anus and the scrotum.

Hafada (scrotal): This is a surface piercing done anywhere on the scrotal skin. It does not penetrate deep into the scrotum.

Lorum: This piercing is done horizontally on the underside of the penis at its base.The position is where the scrotum meets the penis.

Magic cross: This piercing is basically an Ampallang and Apadryava combined together. Making it appear like a cross.

Prince Albert: This is one of the most popular penile piercings. It is a ring type of piercing that goes along the underside of the glans from the urethral opening to the part where the glans meet the shaft of the penis.

Pubic: consists of a piece of jewelry through any part of the area around the base of the penis

Reverse PA: the opposite of Prince Albert, with jewelry entering the urethra and exiting through the top of the shaft


Sexual benefits to penile piercings

  • Some men chose piercings to enhance sexual pleasure for him and or the partner. It can increase pleasure during masturbation or sexual intercourse
  • Depending on the type of piercing, some can stimulate the partner more than others. Especially during vaginal or anal intercourse.


Risks associated with penile piercings

  • Increased risk of UTI (Urinary tract infections)
  • Infection at piercing site.
  • Increased risk of STI
  • Injuring your partner’s genitals during intercourse.

Common signs & symptoms of STIs

Genital piercings are getting more exposure and interest nowadays. Before you decide to get one I suggest you make the necessary research before deciding. When choosing to pierce, I would suggest going to a reputable body piercing specialist. One who has experience and also maintains high standards of cleanliness and hygiene. I highly discourage you from doing it on your own. It’s definitely an acquired taste, so make sure you make the right decision.

Next read: Vaginal Piercings

Also on this site: std screening

 
 
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Congenital Penile Curvature (CPC)

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https://youtu.be/jHytS_EpZ0s

Congenital Penile Curvature

Congenital Penile Curvature, or CPC, is a relatively uncommon condition. It can be noted early in life by parents during diapering and dressing of their infants. Others do not discover the problem until sexual maturity, where they notice the curvature themselves. Often, the penile curvature is only observed in the erect state. CPC can sometimes occur together with hypospadias. This is a urethral abnormality whereby the opening of the urethra is on the underside of the penis instead of the tip. 

The cause of CPC is not known, but is thought to result from excessive elasticity in one aspect of the penis as compared to the rest of the penis. For example, if there is more tissue elasticity on the top of the penis, it expands more than the rest of the penis during erection, resulting in a downward curve. The curve in CPC is typically downwards. 

The degree of curvature ranges from mild to severe. There can be discomfort experienced during sexual intercourse. Men may find that they are only able to have sex in one particular position. Other positions may not be possible due to the nature of the curve. Unlike Peyronie’s disease, which is another cause of curved penis, CPC does not cause painful erections or erectile dysfunction, and there is no fibrous scar tissue that can be felt.

Medical literature suggests that CPC can only be treated surgically by a method known as plication, which involves removing tissue and stitching the opposite side of where the curvature is. 

ESWT – Extracorporeal Shock Wave Therapy

There are no evidence-based non-surgical treatments described. However, from our experience at DTAP, we have observed that Extracorporeal Shock Wave Therapy, or ESWT, is also able to treat CPC with favourable outcomes. We have treated a considerable number of CPC patients with ESWT alone and achieved either full resolution or significant improvement in curvature. 

Therefore, at DTAP we offer ESWT as a treatment option for CPC. We would like to re-emphasize that this is not based on the medical literature, but rather from our personal experiences with patients. It is always recommended to visit a doctor for a detailed consultation, medical examination and assessment of treatment options before making an informed decision on which treatment to undertake.

Also on this site: STD Screening, STD Check Up Singapore

 
 
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7 Things You Need To Know About Anal Cancer In Men

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Anal cancer is a rare disease and the understanding of its natural history is evolving. While it is the 26th most common cancer in the USA annually, the incidence rate is increasing at 2% per year over the past decade. Further underpinning its importance in recent times is that it is also one of the cancers that has devastatingly poor outcomes in the late stage while being relatively easy to detect and treat in the early stages.

What is Anal Cancer?

Anal cancer like all cancers start when the cells lose the ability to maintain their original form. Precancerous changes such as aberrant growth soon occurs as these cells no longer serve their original function and a tumor develops. 

The anal canal is a 4 cm structure that continues from the rectum. Embryologically, this canal develops from 2 distinct stem cells that originate from different parts of the body. As the embryo develops into a fetus, these 2 stems cells develop into either Squamous Cells (outside of canal) or Columnar Cells (inside of anal canal). These 2 cells meet and develop into the anal canal. This is important because the junction at which these 2 cells converge while forming your anal canal all those years ago is also the most susceptible site for developing anal cancer. 

Although not entirely analogous, anal cancer shares many similarities with cervical cancer in women. Both cancers occur most frequently at the junction where 2 normally distinct cells meet and majority of both tumors are found to be co-infected with Human Papilloma Virus (HPV) sub-type 16.

Men who have sex with Men (MSM) and immuncompromised patients (transplant, cancer patients and HIV patients) are more prone to this cancer. Compared to the general population, MSM with no HIV have 2 times the risk of developing anal cancer, MSM with HIV have up to 25 times the risk while transplant patients have 5 times the risk and a patient with previous colon cancer has 20 times the risk. Other risk factors include previous ano-genital warts, previous STD infection and high risk sexual activity.

Anal Cancer In The Early Stages

In its early stages, anal cancer does not produce any symptoms. The early signs of of developing anal cancer is pre-cancerous cell changes. This is detected by direct visualization and sampling of the area. The core principle of screening for anal cancer is hence looking for these pre-cancerous changes. This can be done through a variety of methods depending on the expertise available, each method has different levels of specificity in detecting anal cancer. 

Anal Pap Smear & HPV Testing

Currently, the Anal PAP smear and HPV testing is considered to be the most practical means of screening for anal cancer. This involves a swab inserted into the anal canal and cells from the area are sampled and looked under a microscope for any pre-cancerous changes, further processing of the sample via HPV DNA PCR is also used to detect any presence of HPV in these cells. Once the patients with potential risk of developing anal cancers are pick out with this screening, a further diagnostic test is required. The current diagnostic standard is High Resolution Anoscopy where a high magnification scope is used to examine the tissue. Different reagents are also used to differentiate normal tissue from pre-cancerous tissue. 

There are no established guidelines for how frequent screening should be carried out but current expert opinions recommend every 1 – 2 years for MSM with HIV and 2 – 3 years for MSM without HIV. 

Treatment of Anal Cancer

Treatment of anal cancer can be considered in 2 categories – Pre-cancerous treatment and Cancer treatment. Precancerous changes, once detected by screening and diagnosed with Anoscopy can be treated with either Topical Therapy such to eradicate the precancerous tissues. Local Ablative Therapy that involves Radiofrequency Ablation can also be used to destroy the any precancerous tissue. Cancer treatment for pre-cancerous changes that have progressed to cancer, on the other hand requires surgery.

In both situations, close monitoring post treatment is essential as the recurrence rates are significant especially in high grade pre-cancerous changes. 

Preventing pre-cancerous changes is essential to the approach of reducing anal cancer rates. HPV vaccination is shown to reduce pre-cancerous changes with a recent study showing 75% reduction in both Low and High grade changes in MSM population. There is also data suggesting that vaccination after precancerous changes have been detected is also able to reduce the rate of recurrence by approximately 20%.

In summary, anal cancer is disease in which majority of the tumors are driven by the HPV virus and in which pre-cancerous changes in the patients can accurately predict the chances of developing cancer especially in high risk populations. This makes screening and detection of early disease together with vaccination essential to reducing the rates of anal cancer.

Next read: PENILE CANCER – 7 THINGS YOU NEED TO KNOW!

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Anal Douching – 7 Things You Need to Know!

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Anal douching is the act of cleansing the anal canal and can be done in a variety of ways with a range of products. Many use anal douching to prepare for receptive anal intercourse, however, while it does help with cleaning the area, it is not strictly necessary for anal intercourse.

The anal canal is situated just beyond the rectum, its surface is lined by mucosa layer that amongst other functions, prevents the entry of infective agents such as bacteria into the underlying tissue. Another important structure of the anal canal are the anal sphincters, these muscles line both sides of the canal and maintain fecal continence (keeping your poop in).Tears in the mucosa layers can become infected very quickly, as these wounds further develop into abscesses, they ulcerate through the deeper layers of the anal canal and if the sphincters are damaged, can result in fecal incontinence. 

Overzealous cleansing – too hard or with harsh chemicals results in the mucosal lining of the anal canal to dry out. Dry tissue is “friable” meaning it breaks apart easily thus pre-disposing the anal canal to infection. Therefore, much like how scrubbing your hands with steel wool can give you blisters, anal douching is not entirely bad but must be done in a measured and safe way.

Is douching necessary for Anal intercourse?

No. Clearing your bowels before anal intercourse is useful in keeping your sheets clean and because most bowel movements are able to clear the rectum (the body’s poop storage pouch), gentle cleaning of the external anal canal will suffice in most cases. 

Are laxatives recommended when preparing for anal sex?

Not generally. Laxatives are designed to clear the entire colon which is approximately 1.5 m long. Generally, anal intercourse involves the anal canal (~4cm) and rectum (~15cm), which works out to approximately 20 cm of length or 10 inches (the law of averages would suggest that it enough space for most anal intercourse). A downside of using laxatives is that it can dehydrate you because it pulls water from your body into the colon to give “soften” the contents of the colon. 

Enemas for anal douching?

Enemas for emptying out the rectum and anal canal. It can be seen as a more focused means of cleaning out the area compared to Laxatives. There are however several concerns with enemas.

Firstly the solution used in the enemas can change the chemical balance in that area of your body. This can dry out the mucosa and predispose to damage. The tip of the enema should be soft and insert gently, this will prevent inadvertently tearing the mucosa with the tip of the enema. And lastly, do not share your enemas, studies have found that sharing enemas is a risk factor for the transmission of Sexually Transmitted Infections.

Is using water the best option to clean out your anus?

Yes. Water is generally pH neutral and is not as caustic to the mucosa as some of the chemicals in enemas. Again be careful when inserting anything into your anal canal!

Does over-douching cause you to poop?

Depending on how you do it but generally no. Douching itself is different from laxatives in that it only clears the poop in your anal canal and rectum. 

How long should anal cleansing take?

Anal cleansing should take about 5 – 10 minutes. Again, like washing your hands, overzealous washing can damage the tissue and make it friable. A good bowel moment and gentle washing if the area with water should suffice in getting the area clean.

Does anal douching increase the risk of HIV/ STDs?

Potentially. As mentioned, sharing enemas is a risk factor for contracting STDs even after washing the tip. Because most STDs infect by entering the body through a break in the mucosa, any damage to that layer either by overzealous washing changing the chemical balance of the tissue making friable or mechanical damage with a pointed enema tip create entry points for infective agents that cause STDs to enter the area. To further minimize the transmission of STDs during Anal Intercourse it is hence best to wear a condom.

Also read: Vaginal Douching

 

Penile Cancer – 7 Things You Need to Know!

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The mere mention of penile cancer conjures up much fear and uncertainty among public imagination, especially among grown men. It is not a common cancer in Singapore, hence it is not well known to the public. We shall explore more details in this article about this little known cancer.

What exactly is penile cancer?

Penile Cancer happens when the normal cells of the skin and tissue of the penis turns malignant and grows beyond control, forming a tumour. Penile cancer may eventually spread to other parts of the body including other glands, lymph nodes or organs.

Penile cancer is typically a disease of older men, with most patients around the age of 60 when diagnosed. In developed countries like the USA, Europe, Singapore, penile cancer is rare, accounting for less than 1% of all cancers diagnosed. This is in contrast to less developed countries like South America, Parts of Africa and Asia where penile cancer can account for 10 to 20% of all cancers diagnosed.

Signs and Symptoms of penile cancer

The majority of penile cancers arise from the head of the penis or from the foreskin. The most common findings on examination is a painless lump or an ulcer. The symptoms may include bleeding, rash or balanitis. 30 to 60 percent of patients also have swollen lymph nodes in the groin as well. 

What is the cause of penile cancer?

The majority of penile cancers are squamous cell carcinoma (SCC) and its many variants. Other cancers which can affect the penis include basal cell carcinoma (BCC), Kaposi Sarcoma (KS), melanomas and other lymphomas.

Who is at risk for penile cancer?

  • Patients with previous known medical condition of the penis. This would include warts, infections, previous injury, tears or strictures
  • Phimosis. Uncircumcised males sometimes have a thickening and scarring of the foreskin. This is a condition known as phimosis, which is a difficulty in retracting the foreskin over the head of the penis. 
  • Human Papillomavirus infection (HPV). HPV can be found in 30% to 50% of penile cancers.
  • Smoking and Tobacco Exposure
  • Human Immunodeficiency Virus (HIV) Infection
  • Patients with previous Ultraviolet treatment for psoriasis.

Who to prevent penile cancer?

  • Patients who have phimosis can consider getting a circumcision. 
  • Vaccination against HPV early can also be useful in preventing infection and possible penile/anal cancer. Screening for High Risk HPV through a swab can also be useful in patients who have risk factors.
  • Patients who are smokers should definitely stop smoking not only to prevent penile cancers but other forms of cancers as well.

What are the treatments for penile cancer?

Treatment of penile cancer depends on the type and staging of the cancer. If disease is limited, organ preserving treatment options include topical medications, lasers, radiation therapy or micrographic surgery. If the cancer is advanced and locally extensive, a partial or even full amputation of the penis might be required.

What are the complications of penile cancer?

After treatment, patients might be faced with complications depending on the kind of treatment. For organ preservation treatments, issues with cosmesis, erectile dysfunction and reduced sensation are common. For surgical treatments, for example a penile amputation, patients might require an external opening known as a urethrostomy for urination. Patients might also require a surgical reconstruction of the amputated organ for cosmetic issues.

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“Cheap” Viagra

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From time to time, there has been reports on the news about people suffering ill effects after taking unlicensed, unverified health products which claim to boost the “virility” and “sexual prowess” of men.

In fact, these illegal products often contain different pharmaceutical compounds. In 2008, 10 people died after taking them for sexual enhancement. Diabetes medications were found in these tablets, resulting in people experiencing low blood sugar, dizziness and fainting, cold sweats and eventually loss of consciousness. 

Furthermore because the compounds of the drug are unknown, many have also experienced side effects such as loss of hearing, strokes and extremely painful erections. Not the outcome one would be looking for when wanting to boost their own libido. In fact if left untreated, these painful erections caused by the engorgement of blood can lead to Permanent Impotence.

Image taken from Immigration & Checkpoints Authority Facebook.

These illegal products are often bought from street peddlers, online pharmacies or even from other countries with no prior Health Sciences Authority (HSA) Singapore approval. That being said, here are the top 5 reasons why “Cheap” Viagra may end up costing you so much more than just the money you think you might be saving.

1. You can get severe side effects from unknown doses or what is in the drug

The tablet may contain any combination of medicines to boost erections, other medications that may have adverse side effects such as the diabetes medications i described above. Ultimately leading to organ damage and eventually  death.

The main way medications boost erections are by enlarging the blood vessels in the penis, allowing more blood to flow in. If these engorgement of blood is not regulated and the blood flow is not reversed after a while, it can lead to priapism (engorgement of blood in the penis), painful erections and ultimately impotency. 

Without medical supervision, the penis may eventually have not enough new oxygen from new blood, and after a few hours, critical damage to the penis can start to occur. This is dangerous and is a medical emergency.

2. You could be paying for a dud

Don’t be fooled by catchy packaging names such as King Power, Black Gorilla, Tiger King. Many times, for the sake of selling the tablet, the peddler has no idea what goes into it.

You would be lucky to have avoided an adverse health event, and in this case, have completely no effect at all after taking the tablet. In fact, the scary thing is you might end up taking an additional one or two to get a better effect and end up overdosing on the toxic components of the tablet as well. 

3. You have no idea how these drugs are made

Because there is HSA approval of these illegal drugs, there is no guarantee they are made under the proper conditions. This means you might think you are buying a new Ferrari, but after getting the keys, you realize that either there is no engine or that they have given you a Toyota engine instead. Worse still, they could have given you a spoilt ferrari engine, and after driving for 5mins, the engine explodes and you get caught in the explosion.

4. You may not be getting to the root of your problem

You might also think that these sexual enhancement medications may address your poor erections, but instead there are other root causes or even more effective and safer treatments available that need to be addressed. Testosterone Deficiency Syndrome | Andropause

ESWT For Erectile Dysfunction

This is a novel mode of treatment for Erectile Dysfunction which uses low-intensity shock waves directly to penile tissues to help stimulate the growth of new blood vessels. It has been shown to be safe, painless, and effective for the treatment of vasculogenic Erectile Dysfunction (caused by blood vessel problems such as in people with diabetes and high blood pressure).

If you think you may have Erectile Dysfunction, the first step is to speak to your doctor. There are many safe and effective treatments now available for Erectile Dysfunction, but recommended treatments may vary depending on the underlying cause, age and comorbid conditions such as heart disease.

5. You might think it is very difficult to see a doctor and get real HSA approved medications

With DTAP Teleconsult, we are one call away from addressing your erection concerns in full privacy, medical supervision and support with 3 breezy steps. Furthermore, you do not even need to leave the comforts of your own home to receive the medications you require with DTAP Delivery. All within the same span of the day. This convenience and assurance should be no excuse for you to put your health and life at risk by taking “Cheap” Viagra.

With 15 years of caring, our doctors at DTAP clinic will support you through your men’s health journey professionally, discreetly, and effectively.

 
 
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What happens if you tear or injure your Frenulum?

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The frenulum is the piece of skin that attaches the foreskin to the head of the penis (glans penis). In some men, this part may be short or tight. During intercourse it may be at higher risk of getting torn. 

I feel pain and there is bleeding, did I injure or tear my frenulum?

One of the most common symptoms of a torn frenulum is pain with or without bleeding. It may appear very shocking or scary as blood may be dripping or it may cause a very messy situation in the bedroom.

Common causes for Frenulum injuries/ tear

These tears or injuries are basically caused by a sudden or strong pulling back the foreskin. This causes a strong tension in the frenulum causing it to tear or get injured. This usually occur during intercourse or aggressive masturbation.

How long does it take for it to heal?

Generally if left alone, it takes around 1-2 weeks for it to heal completely. Rate of healing varies between men. If there is any bleeding, it usually stops on its own. If still bleeding, one may need to apply pressure for a few minutes to stop the bleeding.

Treatment options

Conservative: It can heal on its own but will take some time. Even if healed, it will develop a scar and this causes thickening of the frenulum. When thickened, it will become even tighter and hence higher risk of it tearing again. Most of my patients who came to see me report the tears happening several times.

Medical treatment: There is no medical treatment for a torn frenulum. Antibiotic cream may be applied to prevent infection.Surgical: In some cases, pain or bleeding may not stop on its own. In certain instances it may repair with sutures by a medical doctor. This depends on the severity and anatomy of the injury.

How do I avoid getting a Frenulum injury/ tear?

Men with short frenulum or frenulum breve are at higher risk of renulum tears. So the key here to lengthen the frenulum

Conservative: Can try regular stretching of the foreskin and frenulum but this is usually not very useful or successful.

Frenulectomy: This is a simple procedure where the frenulum is cut to release the tension and lengthen the space between the foreskin and the head. The remaining tissue is then stitched together to avoid bleeding and promote faster healing. After this procedure is done, the foreskin can easily move back and forth without risk of tearing the frenulum.

Circumcision: For some men, a frenulectomy procedure may not be enough. They may also have tight foreskin (phimosis) on top of a tight frenulum. This procedure will be able to solve both problems of phimosis and tight frenulum. Circumcision in adults is a simple procedure and can be done at any age. There is no age limit to this procedure.

 

So if you experience any torn frenulum or pain and or bleeding at the frenulum, do consult your doctor. He will have to first do an assessment and physical examination so that he can advice which more of treatment is best for you.

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Delayed Ejaculation/ Inability To Ejaculate (Male Anorgasmia)

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Anorgasmia as the persistent absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress. Related to anorgasmia is delayed orgasm, where a person can still achieve orgasm, but with much difficulty. Delayed orgasm is seen as a less severe form of anorgasmia. These 2 conditions are on the other end of the spectrum of ejaculatory disorders, with the other side being premature ejaculation.

While definitions vary slightly from the World Health Organisation to the International Consultation on Sexual Medicine to the Diagnostic and Statistical Manual of Mental Disorders, one thing is for certain – for males who experience anorgasmia, it causes marked personal distress. 

Anorgasmia can be primary or secondary. Primary anorgasmia means that the person has never achieved orgasm before. Secondary means that orgasm has been achieved in the past, but now can be reached only under specific circumstances or not at all. 

The exact prevalence of anorgasmia is unknown, but numbers can range from less than 1% to more than 5% of males. What we do know is that it is more common in the older population and in people with pre-existing medical, urological, neurological or psychiatric issues.

Causes of Male Anorgasmia

Endocrinological causes include hormonal imbalances such as testosterone deficiency, hyperprolactinemia and hypothyroidism. When these hormones are abnormally low or high, they can not only impair the ejaculatory function, but the erectile function and sex drive as well. 

Medications such as antidepressants (especially SSRIs), antipsychotics and opioids can also cause anorgasmia. This side effect of certain antidepressants has led to the development of a drug known as Priligy, which can delay ejaculation and is used in the treatment of premature ejaculation. 

Some men obtain greater pleasure from masturbation than they do with sexual intercourse. They may continue deep-seated habits such as frequent masturbation or using idiosyncratic masturbation techniques. This hyperstimulation results in a situation where vaginal or oral intercourse may not be able to replicate the stimulation achieved through idiosyncratic masturbation. This may result in reduced penile stimulation during sexual intercourse, leading to difficulty achieving an orgasm.

Penile sensation loss has been shown to increase with age and those with sexual dysfunctions. Age-related loss of peripheral nerve conduction may account for the increased onset over age 50 years. The less sensitive your penis is, the more difficult it is to achieve ejaculation. 

Anorgasmia has also been associated with multiple psychological conditions. Some of these conditions include anxiety, fear and relationship difficulties. Anxiety and fear of hurting the female, impregnating the female, childhood sexual abuse, sexual trauma, repressive sexual education/religion, performance anxiety, sexual anxiety and general anxiety are common. Anorgasmia based on a situational aspect (i.e. difficulties with a specific partner and not another) is more likely to be due to a psychological etiology.

Neurological conditions such as multiple sclerosis, spinal cord issues such as cauda equina syndrome, neuropathy (nerve damage) caused by diabetes, and uncontrolled hypertension (high blood pressure) can also cause anorgasmia. 

Complications from prostate surgery (prostatectomy) or radiation therapy to treat prostate cancer can also result in anogasmia.

Diagnosis of Male Anorgasmia

Your doctor will do a thorough history and physical exam. This should include an evaluation of all medications you take or have taken in the past and past procedures and medical interventions as well. 

Depending on your doctor’s evaluation, they may order further tests including blood tests to evaluate endocrine and hormonal function, sugar levels, a biothesiometry which measures penile sensitivity, a sympathetic skin test, and/ or a sacral reflex arc testing examines the spinal nerves. Imaging investigations may also be done. 

If necessary, your doctor may refer you to a urologist if a physical cause is suspected or a mental health professional if it appears a psychological issue. 

Treatment options

Treatment will depend on the underlying pathology. 

If the cause is due to an underlying disease, management of that underlying disease is the first step in the management of anorgasmia. If the cause is due to a medication, stopping it or changing to a different medication should be considered. If there is a hormonal imbalance, it can be treated with medication to adjust the hormones.

If organic causes are ruled out, the patient may benefit from a thorough psychosexual evaluation (along with his partner). Some psychotherapy techniques that have been used are masturbation retraining/desensitization, adjustments of sexual fantasies, changes in arousal methods, sexual education, sexual anxiety reduction, increased genital stimulation, and role playing an exaggerated orgasm alone and/or with his partner. 

There are some medications that have been used to treat anorgasmia, including Cabergoline, Bupropion, Amantadine and Oxytocin as some. However, these are off-label uses.

Some cases of anorgasmia have also been treated using penile vibratory stimulation (PVS) in patients with penile sensitivity loss. In PVS, a vibrator is applied to the frenular area of the glans penis to produce mechanical stimulation to trigger orgasm.

Male anorgasmia, just like with all types of sexual dysfunction, can take a significant toll on a man’s physical, psychological, and emotional life and result in significant sexual dissatisfaction, as well as that of his partner. The most important step in addressing this condition is to come to a diagnosis, rather than allowing shame, guilt or frustration to get in the way of your relationship.

Next read: Premature Ejaculation

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Does Male Menopause Exist?

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Male Menopause – Andropause

In women, menopause is the time in the women’s life that menstruation and ovulation ends as a result of decreased hormone production. It is diagnosed after a lady has not had a menstrual period in 12 months. Menopause usually occurs in a lady when she hits her late 40s or 50s, but can vary from one female to another. However, this occurs for all females eventually.

The term “male menopause” or andropause refers to age-related declining testosterone levels. In contrast with menopause where all females will eventually experience, the drop in testosterone levels may not occur in all men. In fact, a 50 year-old man can have a higher level of testosterone than say a man in his 30s. Menopause also involves a complete shutdown of reproductive capability in females, but a man in his 70s can still father a child. While it is still possible for a female to get pregnant in her 70s, it is exceedingly rare. Because of these facts, some people doubt whether male menopause truly exists. 

However, there are a few things we know. Testosterone levels can vary greatly among men but in general, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. 

Other names for this condition are testosterone deficiency syndrome, androgen deficiency of the aging male and late-onset male hypogonadism.

What are the key signs and symptoms of andropause?

The signs and symptoms of andropause is because of a drop in testosterone levels in an aging male. 

A person with andropause may experience a decline in sexual function. This might include reduced libido or sexual desire, erectile dysfunction, fewer spontaneous erections both during the day and night, and infertility. 

Some physical changes may occur, including reduced muscle bulk and strength, increased body fat, and decreased bone density. Swollen or tender breasts (gynecomastia) and loss of body hair are possible. Some may experience hot flashes. Others may report decreased energy levels. The testes might become smaller as well. 

Emotional changes may occur. Some examples include a decrease in motivation or self-confidence. Mood issues such as feeling sad or depressed may occur. Some may have cognitive issues such as trouble concentrating or remembering things. Some people may have difficulty sleeping as well. 

What are some of the aging-related hormone changes in men? Does this mean (the person) has andropause?

As mentioned above, the primary hormonal change in men is a decrease in testosterone levels. Other hormones such as growth hormone, prolactin and IGF-1 may decrease. Estradiol levels may decrease as well, but in some older males, due to increased fat mass, they may have increased estradiol levels which offsets the natural decline in estradiol levels. A hormone that tends to increase with age is the thyroid stimulating hormone (TSH). Gonadotrophin levels also tend to increase in response to dropping sex hormone levels. 

For the sake of this article, we would just be focusing on testosterone. As doctors, we do not just look at the testosterone level of the patient. We also take into account what symptoms the patient is presenting with. A gentleman may have a low testosterone level and not be bothered at all about it as it may not present with significant symptoms in him. In another gentleman, with a low-normal testosterone level may present with a whole barrage of symptoms that are affecting his life. In these 2 cases, we are more likely to diagnose and treat the second gentleman. 

It is important to note that decreased levels of testosterone may sometimes be attributed to other causes such as medications such as steroids or psychiatric medications, medical procedures such as chemo or radiotherapy, other medical conditions such as kidney conditions, tumours and hemochromatosis, inflammatory conditions such sarcoidosis, and histiocytosis, and chronic infections such as HIV and tuberculosis. Your doctor will run through your past medical history when evaluating your symptoms as well. 

Do I need treatment for andropause? 

Whether or not you need treatment for andropause depends on your symptoms, and to what degree your symptoms are affecting your work, relationships and life. 

Testosterone levels can be easily measured with a simple blood test. Other hormones and other blood tests are usually conducted at the same time. The best time to come for a blood test is in the morning when the testosterone levels are at its highest. No fasting is necessary for the blood test.

For men with truly low testosterone levels, testosterone replacement therapy (TRT) tends to result in the reversal of the symptoms mentioned above, improved quality of life and has health benefits as well.

What are the treatment options?

Lifestyle changes are always recommended for people presenting with andropause. Exercise and weight loss, stress reduction, adequate sleep and a healthy lifestyle and diet can sometimes raise your testosterone level marginally. 

In conjunction with that, we can do TRT as well, where we can replace testosterone through  pills, injections, patches or gels. The dose and frequency of delivery of testosterone varies from person to person. Doctors will usually do regular blood tests to look out for complications and to tailor the correct dose for you. 

What are the side effects and complications?

While people with true testosterone deficiency report marked improvement in symptoms, TRT is not without risk. TRT can contribute to sleep apnea, stimulate noncancerous growth of the prostate and stimulate growth of existing prostate cancer. Testosterone therapy may also increase the risk of heart attack and stroke and contributes to the formation of blood clots in the veins. It can also cause acne or other skin reactions, limit sperm production, cause testicle shrinkage and enlarge the breasts. It is therefore important to weigh the risks versus the benefits in starting TRT, and monitor for complications should any arise. 

While ageing is inevitable, andropause and its symptoms can be managed with improved quality of life as a result. Speak to your doctor to see if you do have the symptoms mentioned above and if your testosterone levels are truly low, to see if TRT is suitable for you. 

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