Diabetes in Men & 5 Associated Men’s Health Conditions

By 2030, the number of Singapore residents above 40 with diabetes is projected to increase by another 200,000 from about 400,000 today. 

The prevalence of diabetes among adults increased from 8.2% in 2004 to 11.3% in 2010. A higher proportion of men were diabetic (12.3%) compared with women (10.4%). We can imagine how the number would have increased even more by today.

For men living with type 2 diabetes, they are also at higher risk for certain conditions as compared to other men. In this article I will share more about unique mens health issues faced by men with type 2 diabetes.


1. Erectile Dysfunction (ED)

According to a study published in Journal of Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, men with diabetes are much more likely to experience Erectile Dysfunction than men who don’t have diabetes. High blood glucose causes damage to small blood vessels and/or  nerves like the ones that supply the penis. Hence poorly controlled diabetes contributes to Erectile Dsyfunction.

Other than sugar control, there are also some diabetic medicines that causes side effects like ED which adds on to the problem.

Other than diabetes, these men are usually also obese and suffering from hypertension, both of which also adds on to the risk for ED.


2. Urinary Tract Infection: 

Urinary Tract Infection (UTI) is usually caused by bacteria. It can affect any part of the urinary tract. Anywhere including the kidneys, bladder, ureters, urethra, and, in men, the prostate gland. Most of the time the infection is in the bladder. Women are 10 times more likely to get a UTI as compared to men. However men with diabetes are at a higher risk of getting UTIs than men without diabetes.

Why are men with diabetes more prone to UTIs? There are a few possible reasons. One, men with diabetes have poor circulation. This reduces the ability of white blood cells to travel in the body and fight off any kind of infection. Two, high glucose levels can also raise the risk of a UTI. Three, some men with diabetes have poor ability to empty their bladders. What happens is, urine stays in the bladder for too long and this becomes conducive for bacteria to grow.


3. Balanitis

Balanitis is an infection of the skin on the head (glans) of the penis. In uncircumcised men, this area is covered by the foreskin, or prepuce. Balanitis can occur in both circumcised and uncircumcised men, however, uncircumcised men are at higher risk for balanitis and also recurrent infections.  

Any man can develop balanitis, but the condition is most likely to occur in men who have phimosis (tight foreskin) or poor hygiene. Other than this group of men, men with diabetes are also at high risk of balanitis especially if they have poor sugar control. When sugar is poorly controlled, excess sugar may be exreted in the urine. This sugar rich urine when trapped underneath the foreskin, will provide a conducive environment for yeast and bacteria. On top of that, men with poorly controlled diabetes is also unable to fight of infections effectively. Read: What are the Causes of Balanitis


4. Posthitis

Posthitis is inflammation of the foreskin It is characterized by swelling or redness of the foreskin. In some cases, it may happen together with tears on the foreskin which may be quite painful. It is usually caused by an infection like fungus or bacteria. In some cases, it might be due to tears in the skin due to abrasion or friction during intercourse. The selling may lead to phimosis and tightness of the foreskin which makes it difficult for the skin to retract. 

Circumcision is usually a definite treatment for men who has recurrent balanitis posthitis or UTI. It is a very effective treatment to reduce the risk of UTIs, balanitis and also there won’t be anymore posthitis when the foreskin is removed.


5. Low Testosterone

 In the past few years, scientists have found some connection between low testosterone and diabetes. One study showed that in 2,100 men over age 45, the odds of having low testosterone were 2.1 times higher in men with diabetes. Low testosterone doesn’t cause diabetes but it might be the other way around. Men with diabetes might develop low testosterone. Read Andropause

A link between diabetes and low testosterone is well established. Men with diabetes are more likely to have low testosterone while men with low testosterone are more likely to develop diabetes as well. Testosterone improves the body’s ability to take up sugae in response to insulin. Men with low testosterone may have insulin resistance. In this condition, their body need to produce more insulin in order to reduce the same amount of sugar in the blood.

Read: Low Testosterne & Low Libido


All in All

So if you happen to be diagnosed with type 2 diabetes, do keep a look out for some of the issues mentioned above. If you happen to have any of the above conditions, do consider health screening as any of the condtions might be an indication of diabetes. Do consult your doctor if you are experiencing any of the above symptoms and conditions.


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Erectile Dysfunction (ED) Singapore – In a Nutshell

In this video, we are going to talk about a topic that some people may find embarrassing – Erectile Dysfunction or ED for short.

ED is a very common condition. In one study, more than 50% of men in Singapore reported some form of ED. The prevalence increased from 43% in their forties s to almost 80% for men in their sixties. 1 

Aside from affecting your quality of life and relationships2, ED is also an important marker for general health. ED could be the first sign of a chronic disease like Diabetes, High Blood Pressure and High Cholesterol.2,3

Not being able to achieve an erection at all is considered severe ED. Milder forms of ED include not being able to sustain an erection and also not being as firm or hard as you used to be. 4

When you see a Doctor for ED, he will first ask you a detailed medical history and conduct a physical examination.5 He may also need to conduct some tests to find out if there is a medical problem causing your ED. 5

Nowadays, there are many effective treatments for ED. Tablets called PDE5Is are safe, convenient, painless and effective for treating ED. 6,7 Other treatment options include low intensity shock wave therapy8, penile injections9 and penile implants.10

Watch How Do You Inject Caverject

If you feel that your erections are not what they used to be, see your GP and tell him you may have ED and get yourself treated. There is no need to be embarrassed and suffer in silence. 

If you have wish to speak to a doctors about Erectile Dysfunction problem or learn more about treatment for Erectile dysfunction, please contact our men’s health clinics.

References:

1. Tan JK et al. (2003). Erectile dysfunction in Singapore: prevalence and its associated factors—a population-based study. Singapore Med J; 44: 20–26.

2. Paraskevas, K.I. et al. (2009) Erectile dysfunction: a warning sign of silent vascular disease Int Urol Nephrol; 41: 909

3. Cappelleri, J., Rosen, R. (2005). The Sexual Health Inventory for Men (SHIM): A 5-year review of research and clinical experience. Int J Impot Res; 17: 307–319

4. Dutta TC, Eid JF. (1999). Vacuum constriction devices for erectile dysfunction: a long-term, prospective study of patients with mild, moderate, and severe dysfunction. Urology; 54(5): 891–89

5. L.A. Levine (2000). Diagnosis and treatment of erectile dysfunction. Am. J. Med; 109: 3-12

6. Gresser U, Gleiter CH. (2002). Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil and tadalafil—review of the literature. Eur J Med Res; 7: 435–46

7. Sheila A Doggrell. (2005) Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction. Expert Opinion on Pharmacotherapy; 6(1): 75-84

8. Kitrey, N. D., Gruenwald, I., Appel, B., Shechter, A., Massarwa, O., & Vardi, Y. (2016). Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham Controlled Study. Journal of Urology, 195(5), 1550–1555.

9. Heaton, J. et. al (2001). Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. International Journal of Impotence Research, 13(6), 317–321.

10. Montorsi, F.et.al. (2004). Penile implants in the era of oral drug treatment for erectile dysfunction. BJU International, 94(5), 745–751.

How To Apply Testosterone Gel (Androgel)?

What is Testosterone Gel (Androgel)?

This medicine contains testosterone, a male hormone produced naturally in the body. This medicine is used in adult men for testosterone replacement to treat various health problems caused by a lack of testosterone such as male hypogonadism. 


What do you need to know before you use Androgel?

Do not use this medication if:

 If you are allergic to testosterone or any of the ingredients of this medicine (listed in section 6),

– If you are suffering from prostate cancer,

– If you are suffering from breast cancer.


How to apply?

The recommended dose is 5g of gel (i.e.50 mg of testosterone) applied once daily at approximately the same time, preferably in the morning.

The daily dose may be adjusted by your doctor, on an individual patient basis, not exceeding 10 g of gel per day.

The gel must be gently spread onto clean, dry, healthy skin as a thin layer on the shoulders, arms or stomach.

After opening the sachet, the entire contents should be taken out of the sachet and applied immediately onto the skin.

Allow the gel to dry for at least 3-5 minutes before dressing.

Wash your hands with soap and water after applying.

Do not apply to the genital areas (penis and testes) as the high alcohol content may cause local irritation.


Possible transfer of testosterone

During close and relatively long periods of skin contact testosterone may be transferred to another person unless you cover the treated area and could result in the other person showing signs of increased testosterone such as more hair on the face and body and a deepened voice.

It may cause changes in the menstrual cycle of women. Wearing clothes covering the application area or washing the application area before contact protects against such transfer.

The following precautions are recommended:

For the patient:

– wash your hands with soap and water after applying the gel,

– cover the application area with clothing once the gel has dried,

– wash the application area before making close contact with another person.

If you believe testosterone has been transferred to another person (man, woman or child), this person should:

– wash the affected area of skin immediately with soap and water,

– report any signs such as acne or changes in the growth or pattern of hair on your body or face to your doctor. You should preferably wait at least 1 hour before showering or bathing after applying this medicine.


How to store Androgel

This medicinal product does not require any special storage conditions. Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the box.

Avanafil For Erectile Dysfunction

Phosphodiesterase 5 Inhibitors (PDE5i) are a class of medications used to treat Erectile Dysfunction. They are the first line of therapy in men who are present with symptoms of having poor quality of erections. As mentioned in our previous articles, a healthy erection is one of the cornerstones of male reproductive health– Men’s Health Clinic Singapore

Not all PDE5i are made the same, understanding how each one works will allow better discussion with your attending physician when deciding which medication will work best for your situation. In general, inhibition of PDE enzymes in the body results in the dilatation of blood vessels throughout the body. Consequently, medications such as PDE5i that enhance erections can lead to unwanted side effects of headaches and back pain. Medical research therefore has been focused on creating ED medications that are more focused on inhibition PDE5 only in order to enhance erections with minimal side effects.

Avanafil is an example of a highly specific PDE5i and has the potential benefits of providing good quality erections with minimal side effects. Studies done on the molecular binding of Avanafil have shown that it is 110-fold more selective to PDE5 than other PDE5 inhibitors. The additional benefit of Avanafil is the faster absorption of the medication compared to the other PDE5i. A faster absorption translates to faster onset of the medication, therefore with an absorption of 30 to 45 min makes it the fastest acting PDE5i at the moment. One of the largest clinical studies for the medication involving 600 patients showed a significant improvement in erection quality at 100mg and 200mg doses.

Although more specific than other PDE5i, Avanafil does still result in the common side effects of the medication class albeit to a lesser extent. These side effects include headache, flushing and nasal congestion. Absorption of Avanafil is affected by fatty food with a 20% decrease in absorption which translates to a 1 hour delay in onset. 

Avanafil is a good addition to the PDE5i class of medications that help men suffering from ED. Avanafil is only available with a Doctor’s prescription. Discussing your concerns with your attending physician can help you create a treatment plan to include Avanafil or the other PDE5i medications can help you achieve better quality erections and enhance your reproductive health.

Speak to our doctor today to find out if Avanafil is suitable for you.

Avanafil is available at our clinics.


References:

  1. Mehrotra N, Gupta M, Kovar A, Meibohm B. The role of pharmacokinetics and pharmacodynamics in phosphodiesterase-5 inhibitor therapy. Int J Impot Res. 2007;19:253-264
  2. Goldstein I, McCullough AR, Jones LA et al. A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction. J Sex Med. 2012;9:1122-1133

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:

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!


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


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


Find a doctor | Make an appointment

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?


Find a doctor | Make an appointment

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.


Find a doctor | Make an appointment

Fake/ Counterfeit Viagra

Viagra is a medication prescribed by doctors to treat men with erectile dysfunction. There is such a huge demand around the world that Viagra is also one of the most popular counterfeit drugs in the market. 

So let’s find out more about fake Viagra.

Are they harmful?

Counterfeit Viagra medication are drugs that are labeled as Viagra but are not actually the same as the original Viagra. These drugs do not go through the same safety standards or quality control as the original Viagra. According to WHO,

“Substandard and falsified medical products may cause harm to patients and fail to treat the diseases for which they were intended” . Some of these counterfeit drugs may contain other harmful substances or ingredients that may cause detrimental effects. Some have reported the fake Viagra to contain blue printer ink, rat poison, floor wax or even human fetuses. So it’s definitely harmful to you.

What to watch out for? (How to know you’re taking the real pill?)

The best way for you to know if you’re getting the real pill is by obtaining it from a licensed medical clinic or pharmacy. In Singapore, only a licensed medical doctor can prescribe Viagra and only a licensed pharmacy can dispense it. If you order yours online or from any other source, you cannot guarantee its authenticity. 

Why do people take fake/ counterfeit viagra?

Nowadays many people seek information online. Some may feel that they know enough after reading online and that they can go ahead and get Viagra on their own without consulting a doctor. Some may want to avoid having to speak to someone about their problems and rather just solve their issues on their own.

Some men may choose fake drugs as they are cheaper than original drugs. Of course they are cheaper as they did not have to go through safety checks and regulations. It may be cheaper in price but it may be costlier if it affects your health and for some people may even cost them their life.

Complications that could arise due to taking fake drugs

Some of the documented problems that have happened from taking fake Viagra includes but not limited to the following:

  • Visual problems
  • Fainting
  • Dangerous changes in blood pressure
  • Heart problems
  • Low blood sugar
  • Death

Where can you get real viagra?

If you are suffering from Erectile Dysfunction, do consult your doctor to seek medical advice. If Viagra or similar drugs are appropriate, the doctor will prescribe you with those drugs. There may also be other forms of treatment that may be more suitable for you and your condition. Please only obtain Viagra from a medical clinic or a licensed pharmacy.

In Singapore you will need a doctor’s prescription to purchase one.

If you don’t need it to buy that Viagra, this is highly suspicious and it may be counterfeit. So if ever in doubt, speak to your doctor and seek professional help. 

Next read: WHERE TO BUY VIAGRA, CIALIS, LEVITRA IN SINGAPORE – VIAGRA SINGAPORE

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!

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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.