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Movember 2020 | Testicular Cancer

Testicular cancer represents only about one percent to two percent of all cancers in males, but is one of the most common cancers in young men. It occurs predominantly in young males aged 20-40 years old.

Signs & Symptoms

Typically, patients present to their doctor with a painless lump in one or both testes. Occasionally, there may be a heavy or aching sensation in the testes. In advanced cancer, other symptoms may be present. For example, if cancer has spread to the lungs, there may be shortness of breath.


Common Causes

Males who have a history of undescended testes (testes that did not descend to lie in the scrotum during development) have a much higher chance of developing testicular cancer. Other risk factors include history of testicular cancer in the other testis and family history of testicular cancer.

Diagnosis

Ultrasound of the testes will locate and delineate the size of the testicular lump.

Blood tests are taken for tumour markers consisting of alpha-fetoprotein (AFP) and beta-human chorionic gonadotrophin (hCG), and lactate dehydrogenase (LDH). 

A computed tomography (CT) scan of the chest, abdomen, pelvis, and occasionally, the brain, is also performed to find out the extent of cancer.

Prevention:

There’s no known effective prevention for testicular cancer. However, regular testicle self examination may be useful.

Testicular Self-exam

So start a conversation with your friends and loved ones. Create awareness. Encourage those at risk to seek help. Together we can help to reduce disability and deaths among men from the above conditions.

Mental Health | Movember 2020

Latest statistics show that the number of male suicides in Singapore is double that of women. 

Mental health experts are not surprised by this finding. Men are generally less willing to express their vulnerabilities. They usually feel it’s not manly to be sharing their feelings or problems. 


Suicide prevention service Samaritans of Singapore (SOS) said 239 men committed suicide in 2017, compared with 122 women.

The majority of the men were 60 years old or older.

• Men are often reluctant to openly discuss their health or how they feel about the impact of significant life events;

 • Men are more reluctant to take action when they don’t feel physically or mentally well, and; 

• Men engage in more risky activities that are harmful to their health. 

These behaviours are strongly linked to adherence to some harmful aspects of traditional masculinity. Men often feel pressure to appear strong and stoic, and talking about feeling mentally or physically unwell can be perceived as weakness. By allowing negative and harmful aspects of masculinity to be considered the norm, men feel there’s only one way they can be considered “manly”.

How to prevent it?

Use the ALEC model

Ask

Start by asking how he’s feeling. It’s worth mentioning any changes you’ve picked up on: has he stopped replying to texts? Does he sound different on the phone? Has he gone quiet in the group chat? Use a prompt like,”You haven’t seemed yourself lately – are you feeling OK?”
Trust your instinct. Remember, people often say “I’m fine” when they’re not, so don’t be afraid to ask twice.

You can use something specific you’ve noticed, like, “It’s just that you haven’t been replying to my texts, and that’s not like you.”

Listen

Give him your full attention. Let him know you’re hearing what he’s saying and you’re not judging. You don’t have to diagnose problems or offer solutions, but asking questions lets him know you’re listening. Ask a question like, “That can’t be easy – how long have you felt this way?”

Encourage Action

Help him focus on simple things that might improve how he feels. Is he getting enough sleep? Is he exercising and eating well? Maybe there’s something that’s helped him in the past – it’s worth asking. Suggest that he share how he’s feeling with others he trusts. This will make things easier for both of you. And if he’s felt low for more than two weeks, suggest that he chat to his doctor.

Check In

Follow up your conversation with a phone call or FaceTime. This helps to show that you care; plus, you’ll get a feel for whether he’s feeling any better.

Where to seek help?

Samaritans of Singapore: 1800-221-4444

Singapore Association for Mental Health: 1800-283-7019

Institute of Mental Health’s Mental Health Helpline: 6389-2222

Care Corner Counselling Centre (Mandarin): 1800-353-5800

Shan You Counselling Centre (Mandarin): 6741-0078

Silver Ribbon: 6386-1928

Tinkle Friend: 1800-274-4788


Start a conversation with your friends and loved ones. Create awareness. Encourage those at risk to seek help. Together we can help to reduce deaths among men from the above conditions.

Prostate Cancer | Movember 2020

Movember is a month to create awareness for Men’s health. 

Why do we need to create this awareness? 

There are an increasing number of men suffering from specific conditions unique to men like prostate cancer, testicular cancer and also mental illness. On top of them there are more men dying from these conditions. 

In this article, we will touch on prostate cancer.

Prostate cancer

Prostate cancer is the 3rd most common cancer diagnosed in males in Singapore and accounts for 12% of all male cancers diagnosed from 2008 to 2018. According to the Singapore Cancer Registry report from 2015, the incidence has been increasing from 9.7 per 100,000 previously to 28.5 per 100,000 in 2008-2012.

Males in Singapore have a higher rate of prostate cancer than their counterparts in Asia, for example, China, Japan and India. Locally, Malay and Indian men appear to have a lower risk of prostate cancer as compared to Chinese men at about 15.9-17.9 per 100,000 as compared to 25.6 per 100,000.


What is Prostate Cancer?

Prostate cancer is cancer that occurs in the prostate.

The prostate is a walnut shaped gland located just below the bladder surrounding the urethra. The prostate’s function is to produce seminal fluid. This fluid is necessary to nourish and transport sperm that is produced in the testes.


Who is at risk?

Prostate cancer can affect any man. However some are at higher risk than others.

These include:

  • Men above 50. The risk of prostate cancer increases with age especially after the age of 50. More than 80% are diagnosed in people 65 years and older.
  • Family history of prostate cancer. 20% of prostate cancers occur in men who had a history of prostate cancers in their family. This type of prostate cancer is due to inherited genes and shared environmental or lifestyle factors. Having a brother or father with prostate cancer increases your risk 2 to 3 times. Having a sister or mother with breast or ovarian cancer also increases your risk.
  • Ethnicity – Men of African ancestry are at higher risk of prostate cancer compared to men of other races. 
  • Obesity – Men with BMI higher than 27.5 are at a higher risk for many different types of cancers including prostate cancer. Lack of physical activity and poor eating habits are also contributing factors.

Prostate Cancer Screening

  • Prostate Specific Antigen (PSA): This is a blood test that looks out for a protein released by the prostate. This level is usually elevated in benign prostate enlargement, prostate cancer or prostate inflammation.
  • Digital rectal examination: This is a medical examination performed by the doctor. The doctor will place his finger gently in the back passage (rectum) to feel the texture and size of the prostate. In prostate cancer it may be enlarged or have abnormal nodules.
  • Family history: The doctor will ask for any history of prostate, ovarian or breast cancer in the family.
  • Prostate Biopsy: An ultrasound guided biopsy is performed to determine the presence of cancer. This is usually performed if any of the previous screenings mentioned above is suspicious for prostate cancer.

Prostate Cancer Screening Singapore


How do we prevent it?

Fruit and vegetables: Consuming a wide variety of fruits and vegetables has moderately good evidence to reduce prostate cancer risk. Garlic and spring onions has been shown to boost immune system and reduce prostate cancer risk

Lycopene, green tea, soy products and pomegranate: Some limited evidence has shown that the above foods may reduce prostate cancer risk. You can obtain lycopene in cooked or processed tomatoes, watermelon and guavas.

Maintain a healthy weight: Obesity is a known risk factor for prostate cancer. Obese men are at higher risk for developing aggressive forms of prostate cancer.

Stay active: Higher physical activity shows a small to moderate protective effect against developing prostate cancer especially advanced  cancer. Exercise helps to boost our antioxidant defense and fight cancer causing changes in the body.

Reduce fat intake: A higher fat intake has been associated with a higher risk of prostate cancer and its progression. By reducing your fat intake from animal and dairy sources, it can improve cardiovascular health and reduce risk of prostate cancer.

Quit Smoking: Smoking has a significant impact on occurrence of prostate cancer that can lead to death. Smokers were 20% more likely to develop prostate cancer compared to non smokers. By not starting or quitting smoking, it reduces your risk of getting advanced prostate cancer.

With the above information, I hope it can help you make the right decision in prevention and screening for prostate cancer. Do consult your doctor if you would like to screen for prostate cancer or if you have any urinary symptoms.

Other articles on prostate health: Prostatitis, Enlarged Prostate What You Need To Know, Prostate Cancer Screening & What you need to know about prostate massage.

7 Common Causes For Painful Ejaculation

Should pain come right after delightful joy with your partner? No! There is no such thing as extreme joy culminating in sharp pain. If it happens to you, my friend, you need to get some advice.

Painful ejaculation is the most simple term to describe it. There are many other terms in the dictionary like dysejaculation, odynorgasmia, post orgasmic pain, dysorgasmia or orgasmalgia, etc etc but really there is no other simpler term to describe it but painful ejaculation.

To be honest it is quite a common but poorly understood phenomenon associated with sexual dysfunction. 

It actually happens in  1–10% in the general population depending where you live and it actually increases to 30–75% among men who suffer from chronic prostatitis or chronic pelvic pain syndrome.

The severity of painful ejaculations may vary from a minor discomfort to excruciating pain (Really it may occur anywhere including penis, scrotum and perineal/perianal region, you get the idea…) The pain typically starts immediately before or during ejaculation and commonly lasts between 2 to 24 hours. It can be so painful that you can get turned off and your partner dissatisfied and concerned at same time.

So why do we have this happening?


7 simple reasons why

1. Infections, infections, sexually transmitted infections.

 One other thing that all men share besides our obvious anatomy, is our prostate.

The prostate is like the major town where our semen has to flow through and contributes to the flow. Imagine if there is congestion at the town caused by inflammation and foreign bacteria attacking. The very thought itself is painful. Chlamydia is often one STD/STI that results in prostatitis.

2. Stones

Nope, not the rolling stones but the ones that get stuck in the seminal vesicles which are like the canals of Venice but in our town of prostate.

3. Nerve causes

Sexual neurasthenia, wow big word here but it just means sensitive nerves firing off ad nauseam till they are painful and tired out.

4. Drugs

Essentially there is a small risk with all antidepressants: tricyclic antidepressants (TCAs, e.g. clomipramine, imipramine, desipramine, protriptyline, amoxapine), the selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine), venlafaxine and the MAOIs

5. Prostate issues

Yes, the prostate itself can have issues with its own inhabitant cells with inflammation of prostate , prostate cancer, benign prostatic hyperplasia .

6. Post operation

Any prostate surgery , pelvic radiation and hernia repair amongst others.

7. Psychiatric

Sometimes it has nothing to do with the town but the overall governance of the town.

Psychological issues may also be the cause of painful ejaculations, especially if the patient does not experience this problem during masturbation.

Idiopathic – sometimes things just happen.


What can doctors do for us? Rigorous medical and sexual history! This along with chronological order of events is very important to finding out why. The type and location of the pain matters too. It is just not enough to tell the doc pain pain.

He/she will then do a focused physical examination that may disclose scars from previous surgeries or radiotherapy in the groin area whereas skin lumps and penile discharge may be suggestive of sexually transmitted diseases. Palpation of a swollen and painful prostate during digital rectal examination is a diagnostic finding for acute prostatitis whereas a nodule can be felt in the presence of a prostate cancer. 

Similarly, a urine test may confirm the location of urinary infection and confirm the diagnosis of prostatitis. And blood tests for prostate specific antigen levels may also suggest prostate issues if raised.

Abdominal CT scans are rarely required. MRI studies may be helpful when investigating the cause of pudendal neuropathy. However, no obvious aetiology is found in a significant number of patients with the complaint of painful ejaculations, despite extensive investigation. Which lies in our Idiopathic category above.

Treatment of painful ejaculation must be tailored according to the underlying cause, if detected. 

Remember friends, painful ejaculation should never ever be taken for the peak of joyous fun with your partner. Stay safe!

Next read: Delayed Ejaculation | Premature Ejaculation

Epididymitis

The epididymis is a ductal system behind the testis and serves as a conduit for sperm produced in the testicle to be transported into the Vas Derferens to eventually reach the urethra. Epididymitis is a condition where the epididymis becomes inflamed usually from an infection, though trauma and autoimmune disease is a possible cause.


Signs & Symptoms

Symptoms of epididymitis include localised testicular pain and swelling of the posterior aspect of the testicle. The area can sometimes be warm to touch with redness of the scrotal skin. The area will be  painful when being examined with relief of the pain achieved when the area is elevated. 

Severity and etiology of epididymitis varies with the age of the patient. For young children presenting with testicular pain, a diagnosis of Testicular Torsion needs to be considered first, after which a mumps infection affecting the testicle needs to be ruled out. For sexually active men under 35 years of age, Gonorrhea and Chlamydia are the 2 most common organisms responsible for epididymitis. In older patients, epididymitis can occur concurrently with prostatitis especially if there is an underlying prostatic obstruction such as Benign Prostatic Hyperplasia (BPH) or recent catheterization.

Rapid STD Test for Chlamydia and Gonorrhoea


Most cases of epididymitis can be treated outpatient with oral non-steroidal antiinflamatory drugs (NSAIDS), local application of ice and oral antibiotics. A urine test is sometimes done to determine the organism causing the infection. Patients with epididymitis generally improve within 48 – 72 hours. If the symptoms do not abate within that period, an alternative diagnosis needs to be considered and further imaging such as a scrotal ultrasound performed.

Candidiasis in Men


Candida or yeast infection can affect men too. This may lead to a condition known as balanitis — inflammation of the head of the penis.

Yeast infections in men are common because the fungus that causes yeast infections (candida) is normally present on skin, especially moist skin. 

Balanitis is more common in uncircumcised men.


Signs and symptoms of Balanitis

  • Moist skin on the penis, possibly with areas of a thick, white substance collecting in skin folds
  • Areas of shiny, white skin on the penis
  • Redness, itching or a burning sensation on the penis

You may be more likely to develop balanitis from a yeast infection if you:

  • Aren’t circumcised
  • Use antibiotics for prolonged periods
  • Have diabetes
  • Have an impaired immune system, such as with HIV
  • Are overweight
  • Practice poor hygiene

If you and your partner both have symptoms of a yeast infection, it’s important that you both be treated to avoid reinfecting each other.


Treatment options

Treatment includes topical creams or oral medication. Usually this treatment works well in clearing the infection.

However, in some men, this infection may be recurrent and occurs several times a year. This happens more often among men with diabetes as they are at higher risk of infection. In cases of recurrent balanitis, circumcision would be the best solution to prevent recurrent balanitis.

Do see a doctor if you are experiencing any of these symptoms.

Pain During Ejaculation

What does it feel like?

Pain during ejaculation is also known as dysejaculation, odynorgasmia, post orgasmic pain, dysorgasmia or orgasmalgia. This can range from mild discomfort to severe pain and can occur during or after ejaculation. The usual sites of pain are the penis (along the shaft or at the tip), scrotum, perineal or perianal area.

The pain can last anywhere from a few minutes up to 24 hours. Dysejaculation can be associated with other sexual dysfunctions. It can significantly impair a person’s quality of life and sex life through reduction of the individual’s self-esteem and sexual desire.

Several studies demonstrated its prevalence between 1–10% in the general population, but this may be underreported due as the discomfort may be transient and mild for some people.The prevalence may increase to 30–75% among men who suffer from chronic prostatitis or chronic pelvic pain syndrome. It is also seen in other conditions mentioned below.

Causes 

There are a variety of conditions that can result in painful ejaculations, but it can also be an idiopathic problem with no identifiable cause. Sexually transmitted infections, calculi or stones in the seminal vesicles, damage to the pelvic nerves, inflammation of prostate, prostate cancer, benign prostatic hyperplasia, prostate surgery, pelvic radiation, a previous history of hernia repair or rectal intercourse and certain medications such as antidepressants have all been associated with dysorgamia. 

Psychological issues may also be the cause of painful ejaculations, especially if the patient does not experience this problem during masturbation. Other rarer causes include heavy metal or mercury toxicity or ciguatera toxin fish poisoning.
Also read: 7 Common Causes For Painful Ejaculation

Evaluation

Just with all types of sexual problems, the doctor will start with a thorough medical and sexual history. A history regarding sexually transmitted diseases, relationship issues, psychological or psychiatric issues and drug intake will be taken. The doctor will also be keen to assess any urinary symptoms, prostatic diseases, familial prostate cancer, previous surgical procedures (e.g., hernia repair or prostatectomy) and previous history of radiotherapy. 

Your doctor may do a prostate exam to look for any pain, swelling or nodules which may indicate a prostate pathology. A neurological and musculoskeletal examination may detect a nervous system pathology.

Investigations your doctor might do include a urine or semen culture looking for any infections, especially with sexually transmitted infections. Blood tests for prostate specific antigen (PSA) levels may be raised if it is a prostate issue. Ultrasound scans may also be ordered. No obvious pathology is detected in a significant number of patients. 

Treatment options

Treatment of painful ejaculation should be directed at managing the underlying cause if there is one. 

If an infection is detected, antibiotics will be given. Urological procedures may be done for prostate growth or cancers. If drugs are a suspected cause, changing the medications or stopping it can be considered. Your doctor may prescribe medical treatment such as muscle relaxants, α-blockers, anti-inflammatory agents, certain types of antidepressants and neuropathic pain medications to alleviate the symptoms. Psychotherapy or relationship counselling should be conducted for patients with an underlying psychological issue. Behavioural therapies and pelvic floor exercises have also shown to be helpful. Extracorporeal shockwave therapy (ESWT) can be done for pelvic pain and dysorgasmia which can also alleviate the pain.

If you do experience pain during ejaculation, it is important to seek medical attention and treatment to rule out serious causes and before this issue impairs your sexual function and quality of life. 

Next read: Dysuria (Painful Urination)

Also on this site: hiv test, pep hiv, std test singapore


Dysuria (Painful Urination)

What is Dysuria (Painful Urination)?

Dysuria is the sensation of pain, burning, or discomfort on urination. The pain may be in the lower part of the abdomen, along the length of the penis in males or at the urethral opening in females. It is a symptom which can be due to many different conditions. 


Causes of Dysuria (Painful Urination)

The most common cause of acute dysuria is infection, especially cystitis (infection of the bladder). Other infectious causes include urethritis (infection of the urinary tube) and vaginitis (infection of the vaginal canal). Infections of the prostate may also cause dysuria. These can be due to sexually transmitted infections (STI) or non-STI infections. 

Non-infectious causes can include a foreign body in the urinary tract, certain medication use, urinary tube anatomic abnormalities, trauma, and bladder pain syndrome. Certain autoimmune and psychogenic conditions can cause dysuria as well. 

Dysuria may be accompanied by other symptoms including urinary frequency and urgency, vaginal or penile discharge, pain during sexual intercourse, foul-smelling or blood stained urine, fever and swollen groin lymph nodes.  


Evaluation

The doctor will usually start off with taking a history and performing a physical examination. Crucially, the doctor will also order up some urine tests to be done. These tests can usually tell us the exact organism that is causing the infection. Depending on what the doctor might suspect, other investigations such as radiological investigations (x-rays, ultrasounds or CT scans) and blood tests may be done. If necessary, a urologist may do a scope of the bladder (cystoscopy) as well.


Treatment for Painful Urination

Most of the time, the reason is usually due to a bacterial infection of the urinary tract. For bacterial infections, antibiotics are given to kill off the infection. The type and duration of antibiotics depends on the type of bacteria. Antibiotics in the form of an injection may be given as well. 

If the cause of dysuria is due to a STI, it is imperative that we ensure the bacteria is eliminated completely, and that your sexual partners are tested and treated as well. It is also recommended to screen for other STIs. 

Other symptomatic treatment for dysuria can include medications to ease the discomfort on urination or the other symptoms like urinary frequency and urgency. While these medications do not clear the bacteria by itself, when used in conjunction with the antibiotics, they can provide much needed relief for symptoms that can otherwise be very uncomfortable.

If you do experience dysuria, do not hesitate and seek medical attention and treatment early.

Next read: Vaginal Piercings

Also on this site: hiv test, pep hiv, std test singapore


Penile Discharge – Video

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.

Penile Piercings

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