How to Test for Oral STDs

It is a common misconception amongst both men and women that oral sex (i.e. fellatio, cunnilingus, and analingus) is completely risk-free when it comes to infections. While oral intercourse is often thought to be a safer option compared to penetrative intercourse or conventional sex, the reality is that a variety of STDs can still be transmitted through direct contact with the mouth, lips, tongue or throat.

As such, it is important to monitor for symptoms of these infections as well as proactively test if there is a potential exposure risk, especially as a large proportion of these infections can be asymptomatic, or have symptoms that develop much later.

The most common infections transmissible through oral sex are Chlamydia, Gonorrhea, Herpes Simplex Virus (HSV), and Human Papillomavirus (HPV), and Syphilis. In this article, we will be outlining some of the common symptoms seen with these infections as well as how they can be tested.

Chlamydia and Gonorrhea

These are two of the most common STDs seen globally, and are caused by the bacteria Chlamydia Trachomatis and Neisseria Gonorrhea respectively. They will usually infect the genital region, urinary tract, anus, and oral cavity, although other sites of infection have been noted as well. While symptoms such as sore throat and throat discharge may be present in some individuals, up to 70-80% of throat infections with chlamydia and gonorrhea may be asymptomatic and a large portion will remain undiagnosed and untreated.

The most accurate method of testing for throat chlamydia and gonorrhea infections will be with Polymerase Chain Reaction, or PCR testing – this looks for specific genetic sequences from the DNA of these bacteria. Standard bacterial cultures are usually insufficient to pick up these infections.

Herpes Simplex Virus

There are two main types of HSV infection. Type 1 HSV is more commonly seen, and can be spread through both oral-to-oral transmission such as kissing, as well as oral-to-genital transmission. Type 2 HSV is more typically seen through genital-to-genital transmission, although it can also be spread to the mouth, tongue, and throat through oral sex. These viral infections can cause outbreaks of painful ulcers or cold sores at the site of transmission, and infection is carried lifelong. There is risk of transmission of these infections even without symptoms.

Testing for herpes infections can be performed either with blood serology testing or via PCR testing if there are symptomatic lesions. Serology or antibody testing will only be able to detect possible past exposure 1-3 months after transmission, and is not useful to detect new or acute infections.

Human Papillomavirus

HPV infections are one of the most common prevalent STDs worldwide. There are many subtypes of HPV, usually divided into low-risk and high-risk categories. Low-risk types include type 6 and 11, which are responsible for about 90% of genital warts or papillomas – these are benign, cauliflower-like growths on the skin and mucous membranes that can develop weeks to months after initial transmission. High-risk types include type 16, 18, 31, 33, 45 etc. and are more related to cancer risk, including cancers of the cervix, anus, penis, and mouth/throat. It is estimated that approximately 20,000 HPV-associated oral cancers are diagnosed per year in the US alone.

Warts from HPV are usually diagnosed clinically and do not require any specific testing; however, high-risk HPV infections are usually asymptomatic and would require PCR testing to be detected. Guidelines currently recommend women over the age of 30 to do regular HPV PCR testing together with their pap smears, and for men who have receptive anal sex to screen for rectal HPV if they are HIV positive. While oral HPV testing can be performed with the same type of test, there are no specific recommendations to do so, with the costs and benefits of the test to be determined by the individual and their doctor. HPV infections can be prevented with the HPV vaccine, which is now available for both males and females 9 years of age and older.

Syphilis

Syphilis infection is caused by the bacterium Treponema Pallidum. While incidence of syphilis had initially decreased with the availability of penicillin treatment in the 1940’s, rates of infection have been rising steadily for the past two decades, and it is commonly seen as a co-infection with Human Immunodeficiency Virus (HIV). Syphilis infection can be spread through direct contact to mucous membranes and compromised skin from an infected sore or chancre, usually at the genital region, anus, and mouth; it is estimated that around 20% of syphilis infections are transmitted through oral sex alone. Symptoms will depend on stage of infection at presentation, and can include sores or ulcers in primary syphilis, and a diffuse rash in secondary syphilis. Many cases are not detected when symptomatic and may be considered in the latent stage when screened on blood testing, or may even reach the tertiary stage many years after initial infection – this can cause complications with the heart and blood vessels (cardiovascular system), or with the central nervous system (neurosyphilis).

Syphilis testing is mostly performed with serological tests, which look for certain antibodies in the blood that can be detected 2-5 weeks after infection. Other forms of testing include dark-field microscopy, direct fluorescent antibody, and PCR testing; however, these are rarely performed in the clinical setting due to cost and availability of equipment and experienced lab personnel.

 

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Symptoms of Sexually Transmitted Diseases in Women

Sexually transmitted diseases (STD) are a major issue amongst women of any age. They may lead to a variety of complications as they can affect the reproductive health of women if left untreated. Therefore, it is important to recognize their symptoms and the need for early medical review and treatment cannot be emphasized strongly enough.

Some of the STDs are caused by:

1) Human papillomavirus
2) Chlamydia trachomatis
3) Neisseria gonorrhoea
4) Genital herpes
5) Trichomonas
6) Mycoplasma genitalium
7) Syphilis
8) HIV
9) Hepatitis B
10) Hepatitis C

It is important to note however, that many people with STDs do not know that they carry the infection. This is called asymptomatic infection. Therefore, even if you have no symptoms and are concerned about an exposure that may have been high risk (e.g. unprotected sex, a recent STD diagnosis in a partner, substance or alcohol use during sex or having multiple sexual partners), then STD tests should be performed to rule out asymptomatic infection.

Symptoms that may suggest that you have STD are as follows:

1) Abnormal vaginal discharge

Any discharge that is unusual for the woman such as a change in quantity, consistency, colour (yellow to greenish) and if there is blood mixed in may indicate an infection.

2) Vaginal itch

This is usually felt externally in the vulva area and may indicate an infection within the vagina.

3) Abnormal vaginal odour

A malodorous discharge or odour without discharge may be abnormal and can be caused by STDs.

4) Vaginal discomfort, pain or burning sensation

This can range from a mild discomfort to full-blown pain or a burning and stinging sensation down below.

5) Painful urination

Burning or a painful sensation during peeing or sometimes just a “hot” sensation during the process though may indicate a urinary tract infection (UTI) but do note that it could also point to an STD.

6) Painful sexual intercourse

This is also called dyspareunia and if it feels deeper inside, it may indicate an infection involving deeper areas such as the cervix.

7) Lower abdominal discomfort or pain

This again may mean infection of the deeper structures such as in pelvic inflammatory disease.

8) Bleeding outside of menses

This may again indicate pelvic inflammatory disease but may also be due to sinister conditions like cancer of the cervix.

9) Vulva blisters, sores, ulcers or wart-like lumps that can also involve other areas such as anal and oral areas

STDs can manifest as rashes or ulcers in the vulva areas or other places as stated above. A blister-like rash is typical for genital herpes whereas a single ulcer (painless or painful) may be early syphilis. Genital warts are due to an infection with human papillomavirus.

10) Non-specific flu-like symptoms such as sore throat, mild fever, headache, tiredness and fatigue

Though these symptoms may not seem to indicate anything serious (apart from suspicion of covid-19), a recent infection with viruses such as HIV and hepatitis B and C may manifest with any of these symptoms. These symptoms are due to the body’s antibody production against these viruses, also called ‘acute seroconversion syndrome’. It is important to think about these conditions particularly after a high-risk sexual exposure event.

11) Swollen (painful or painless) lymph nodes either widespread or limited to the groin area

An STD may cause regional lymph nodes to swell up and may cause pain or discomfort.

12) Widespread rash mainly in the trunk or back which can involve palms and/or soles

Generalised rash involving the body which can involve the palms or soles or both is one of the common symptoms of syphilis.

Though you may feel that you are unlikely to have an STD as you don’t feel any symptoms at all, as mentioned earlier, a large proportion of people who have STDs may not exhibit any symptoms. Thus one should exercise caution when it comes to engaging in high-risk activities (e.g. 100% protection including during oral sex, reduce number of sexual partners, avoid alcohol or substance use etc) and to always seek medical attention should a partner is diagnosed with an STD.

The importance of early diagnosis and treatment of STDs cannot be emphasized enough and this is so that the risk of transmission to others is eliminated and to also reduce the risk of development of complications from STDs.

Should you have any concerns regarding STDs or are experiencing any of the above symptoms, do consider making an appointment with us at DTAP clinic.

 

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HIV PrPEP & HIV PEP For HIV Prevention

Transcript from video:

Hi, I’m Dr. Jonathan Ti from Dr. Tan and Partners, and today I’d like to talk about HIV PrEP.

PrEP stands for Pre-Exposure Prophylaxis, and it has emerged in recent years as one of the most effective ways to prevent HIV infection. Individuals taking PrEP can reduce their risk of getting HIV by upwards of 95%. This type of medication must be taken before any risk exposure to be effective. It is different to Post-Exposure Prophylaxis, or PEP, which is taken immediately after a possible exposure and uses additional medications.

PrEP is usually taken as a once daily tablet, a combination of antiviral drugs tenofovir and emtricitabine. Other types of dosing regimens are available as well, depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density, especially with the older version of medication called Truvada. The US FDA recently approved a newer drug called Descovy for use as PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for kidney and bone toxicity. The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters target cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity and side effects.

HIV PrEP is recommended for individuals who belong to a high-risk group for HIV infection, and who do not have any current established HIV infection. HIV high-risk groups may include:

  • Someone who has an HIV-positive partner
  • Someone who has multiple sex partners, a partner with multiple partners, or a partner whose HIV status is unknown and does not practice safe sex; there is higher risk in men who have sex with men or transgender women
  • Someone who has sex with commercial sex workers
  • Someone who has recently had a sexually transmitted disease
  • Someone who injects drugs, or has unprotected sex with someone who injects drugs

Both Truvada and Descovy are available in our clinics. They are only available by prescription. Please speak to our Doctors if you think PrEP is right for you.

WORLD AIDS DAY 2020

On December 1st, the global community unites to commemorate World AIDS Day, showing support for those living with and affected by HIV, and to remember those who have lost their lives to AIDS. This year in particular, the COVID-19 pandemic has laid bare how critically interlinked our health is with issues such as social inequality, human rights, stigma and discrimination, economic security, and political will and stability.

The theme of World AIDS Day this year is “Global solidarity, shared responsibility”. The COVID-19 crisis has demonstrated that, during a pandemic, no one is safe until everyone is safe. We all have a part to play in addressing the dual pandemics of COVID-19 and HIV/AIDS, in order to successfully eliminate them both as a public health threat.

There were approximately 38 million people living with HIV/AIDS in 2019, with an estimated 1.7 million people acquiring HIV in the year, marking a 23% decrease in new HIV infections since 2010. In Singapore, latest figures released in June this year showed 323 new cases of HIV infection reported among residents in 2019, bringing the total number of HIV-infected residents to 8,618 as of end of 2019, of whom 2,097 had passed away. The annual incidence of new infections locally has decreased overall by about 25% when compared to 2007 to 2017.

This decrease of new HIV infections is a result of the concerted and coordinated efforts of both government and community-led initiatives, but there is still much that can be done. In 2014, UNAIDS set an ambitious goal of eradicating the HIV epidemic by 2030. This involved a set of targets called the “90-90-90” vision, which stated that by 2020:

  • 90% of people living with HIV would know their diagnosis
  • 90% of those diagnosed with HIV would be on antiretroviral therapy (ART)
  • 90% of those on treatment would have achieved viral suppression

Singapore has made significant improvements towards the last two goals, with approximately 89% of people diagnosed with HIV on treatment and 94% of those achieving viral suppression; however, we are still relatively lacking in our progress towards the first target, with only an estimated 72% of people living with HIV who have been diagnosed. 

We know that early diagnosis leads to early treatment and better outcomes. Knowing their HIV status early will also help to prevent the spread of infection to others. Providing access to better information and testing for HIV, increasing awareness and uptake of Pre-Exposure Prophylaxis (PrEP), and ensuring long term compliance to antiretroviral therapy (ART) by people living with HIV are some of the primary facets of eradicating the HIV epidemic.

As we approach the end of a tumultuous year, the impact of COVID-19 has forced us to view our global health responses, including the HIV/AIDS response, in a different way. We must now be more committed than ever to ensure no individual or community is left behind – healthcare must be funded and accessible to all, stigma must be eliminated and vulnerable populations offered social protections, and public health systems must be strengthened through investment and sound government policy.

As the WHO has so accurately and succinctly captured:

“Now is the moment for bold leadership for equal societies, the right to health for all and a robust and equitable global recovery. This World AIDS Day, join us in calling on countries to step up their efforts to achieve healthier societies. This World AIDS Day let us demand global solidarity and shared responsibility.”

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Why is my vagina itchy? (Video)

Vaginal itching is a fairly common and unpleasant symptom that most women may experience at some point in their life.

There can be many causes of vaginal itching. While most cases tend to give rise to the discomfort for only a short period of time, some rarer causes may result in long-standing, persistent itching which can significantly affect one’s quality of life.

 Vaginal yeast infection is the most common cause of vaginal itch.

While yeast infections can be easily treated with antifungal medication and creams, recurrence of the infection is common, and many women will experience more than one episode of candidiasis in their lifetime.

 STIs such as chlamydia, gonorrhoea, trichomonas, herpes and genital warts can all cause local skin irritation and itching.

Look out for other signs of STIs, which include abnormal vaginal discharge, abnormal bleeding, or pain during sex.

Prompt investigation and treatment of the STI should help to clear up the itching.

The skin in the vaginal area is also highly sensitive, and exposure to skin irritants can result in itching.

Treatment involves withdrawal and avoidance of the specific skin irritant. In some cases, short-term use of topical creams may be necessary.

Also Read: Why Do I Have Abnormal Vaginal Discharge

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.

Why Keeping Active and Eating Well Are Not Enough – Maintaining Good Air Quality Is Also Key to A Healthy Lifestyle

Given the events of 2020, you are likely spending more time indoors, specifically in your own home, than ever before. While we often put time and energy into eating well and staying active, there is a hidden health culprit in our now more highly frequented home environments that we rarely consider – the air we breathe.

Keeping ourselves and our families healthy during this pandemic is on everyone’s mind. And while many of us can apply nutrition and movement to our health routine, it’s important to remember that good air quality is just as pivotal to our overall health, especially for those who suffer with allergies or respiratory issues.

Maintaining good air quality might seem simple: have good ventilation, control contaminants, and maintain optimal humidity to reduce allergens like dust mites, fungi and mold. Yet, there are many lesser-known challenges of maintaining optimal air quality throughout our indoor spaces.

Without proper knowledge, ensuring the good quality of the air we breathe in our indoor spaces, like our homes, offices and schools, is easier said than done. There are many factors that can affect the air quality in your home and by extension your health, but the variables that affect indoor air quality can be broken down into three main categories: indoor environmental issues, indoor air contaminants, and insufficient air exchange.


Indoor Environmental Issues

Indoor environmental issues include humidity, which can affect your health in two ways. First, if there is too much moisture in the air (high humidity) and you are asthmatic, you may notice an increase in your asthma attacks. High humidity can also contribute to dust mites and fungi spore growth. On the other end, if there is not enough moisture (low humidity), you and your family may suffer from respiratory tract infections frequently.

Other indoor environmental issues include poor air circulation, meaning there is very little airflow or movement in your house. This might be a problem if you have very few windows in your home or office. You may not be in an area where you can leave your door open to let in the fresh air.

Indoor air quality can also be affected by ventilation system issues, specifically the condition of your HVAC system. The air might be unevenly distributed throughout the system. Another problem might be that the exhaust ventilation is insufficient.

Modern homes are particularly vulnerable to this type of problem.


Indoor Air Contaminants

You may be surprised by the number of air contaminants that can affect our indoor spaces and prevent healthy breathing. These include pollutants from human actions such as smoking tobacco. Construction materials in new homes and remodels are also damaging to air quality from resulting particles including fiberglass, asbestos, formaldehyde and dust.

There are also harmful chemical solvents hidden in everyday items like perfume, glues, disinfectants, cleaning solutions, solvents, pesticides, paints and even our carpets and furniture, where bacteria, fungi and molds can live.


Insufficient Air Exchange

In order to keep the air inside as healthy as possible, you should always have good external ventilation of air frequently. Stagnant air carries a higher concentration of aerial contaminants and allergens.


Maintaining Better Health with Healthy Air Quality

There are many hidden health culprits existing in our modern indoor spaces. Even in our own homes. Unlike other elements of maintaining a healthy lifestyle such as exercising or eating well, keeping our air quality clean is low-maintenance and a low-time investment with a simple piece of technology: an air purifier.

While there are several reasons why you should consider an air purifier for your health, we have listed our top five reasons:

1. Keep allergies at bay

Allergy sufferers know how absolutely debilitating an allergy attack can be. Sometimes the symptoms can be quite overwhelming which include sneezing, a runny nose, coughing, post-nasal drip, nasal congestion, itchy nose and eyes.

Regardless of your allergies, an air purifier will help ensure your indoor air quality is at a healthy level, helping you to control and improve symptoms. Air purifiers are also quite adept at filtering out the harmful allergens and are recommended for allergy sufferers, as they provide added protection against severe attacks.

2. Managing pets impact on allergies

Pets are well-known causes of many allergies. An air purifier allows you to have pets even if you have allergies, as it helps to remove pet dander (dead cells from hair and skin) in the environment that may worsen allergic symptoms.

3. Improving respiratory problems

If you or a loved one suffers from asthma or any condition that might be worsened by allergies, an air purifier is an excellent idea. Sometimes attacks are unpredictable so keeping your air clean and healthy with an air purifier helps minimize attacks and makes breathing easier.

4. Improving air quality in a new home

If you have just moved into a new home, it is a good idea to buy an air purifier. It may help to remove harmful irritants like paint fumes leaving the air healthy to breathe.

5. Lessening the impact of tobacco smoke at home

If a loved one is a smoker and you have allergies or breathing issues, it can be tough. However, an air purifier can contribute to cleaner air.

I certainly want you and your loved ones healthy on the other side of this pandemic.

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