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.

Dengue in the era of COVID

While the current COVID-19 pandemic continues to capture all our attention, an arguably more deadly disease which has always been endemic in Singapore continues to wreak its havoc. Often hiding behind the symptoms of COVID-19. This is dengue.

Dengue has been endemic in our shores for as long as our history. As recent as 2019, 15,998 cases of dengue were reported and a total of 20 people died from it. As frightening as these numbers may be, they pale in comparison to the situation developing this year. We are halfway through the year and already the National Environment agency has reported a cumulative total of 12,539 cases of dengue and 12 people have succumbed to the disease. 1,375 cases of dengue were reported in the week ending 20th June. That is almost 200 cases of dengue every single day. The most number of dengue cases ever reported in Singapore was 22,170 cases in 2013 and 2020 looks well placed to break this unenviable record. 


To make matters worse, as we enter the warmer months of the year, the breeding and maturation cycle of the Aedes mosquito accelerates. This means they will reproduce faster resulting in an increase in the number of insect vectors that transmit dengue. In addition, due to the shift in the strain the risk of dengue haemorrhagic fever, the deadly form of dengue, is higher as cross-immunity to different strains are only partial.

It is difficult for doctors to differentiate between the 2 diseases. Dengue and COVID-19 share many similar symptoms for example fever, muscle aches, cough, sore throat and running nose. Given the attention currently heaped on COVID-19, both the patient as well as the physician have to consciously maintain a high level of suspicion for dengue and not be swept up by the publicity.


“As long as it is not COVID” – is not OK. Furthermore, it is absolutely possible that a patient is suffering from both dengue and COVID-19 simultaneously making it even more challenging for a doctor to diagnose. As if all these were not bad enough, a final complication exists which is the blood tests for dengue are not always accurate. This was very well illustrated by a local case report of a patient who presented to his doctor with fever and muscle aches and subsequently tested positive on a dengue test. On further testing, the patient was eventually diagnosed with COVID-19 and it was discovered his initial dengue test was falsely positive. Other supporting blood tests like platelet counts and liver function tests can also show the same abnormalities in both patients who suffer from dengue and patients who suffer from COVID-19 so are also rather unhelpful.


Dengue is not spread from person to person like COVID-19. A mosquito stings a person with dengue and sucks the dengue parasite along with the blood from its victim into itself. Mosquitos do not fall sick from dengue. They fly along to another person and while stinging them, transmits the dengue virus. This means that while social distancing can protect us from COVID-19, it does nothing to protect us from dengue. Dengue can be spread as far as the mosquito can fly. 


The COVID-19 pandemic has created an almost perfect storm for dengue to spread. Just like COVID-19, there is currently no effective way to cure dengue. And just like COVID-19 the solution to the pandemic is to stop its spread. To stop the spread of dengue, we need to stop mosquitoes from breeding. This is where we all have to play our part. As much as we would like to blame the empty construction yards, the reality is it is homes that form the bulk of mosquito breeding grounds. In a single dengue cluster in Singapore, 84% of homes were found to be breeding Aedes mosquitoes. It is up to every one of us to ensure that our homes as well as common areas do not serve as breeding grounds for mosquitoes.

Quote from NEA:

Homeowners and occupants are strongly urged to do their part and pay close attention to any mosquito breeding or adult mosquitoes present in their homes, take the necessary steps to prevent or remove them, and protect themselves from mosquitos’ bites.

These include:

  1. Regularly doing the Mozzie Wipeout and removing any stagnant water in homes;
     
    • Turn the pail
    • Tip the vase
    • Flip the flower pot plate
    • Loosen the hardened soil
    • Clear the roof gutter and drains within compounds, and place Bacillus thuringiensis israelensis (Bti) insecticide inside
  2. Spraying insecticide at dark corners of the home, for example under the sofa and bed, behind the curtains and in the toilets
  3.  Applying mosquito repellent to protect themselves from mosquito bites
  4. Using mosquito screens
  5. Using spatial mosquito repellent (e.g. mosquito coil) in well-ventilated areas of the home.

NEA has published two educational videos to guide residents on the spraying of aerosol insecticide at home , and what to do if one lives in a dengue cluster area or sees mosquitoes at home.

Rapid COVID-19 Testing is available.

Dengue Vaccination – Is it suitable for you?


Next read: FAQS ON THE NOVEL CORONAVIRUS (2019-NCOV)

Also on this site: hiv test


Speak to your doctor for more information or if you have any questions regarding Dengue Rapid Testing or other Dengue related topics: Dengue in the era of COVID, Dengue Fever Symptoms? Dengue Fever What You Need to Know, Why the recent resurgence in Dengue Fever?, ZIKA IS AN STD!! – Battling the STD Stigma


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



Crabs STDs – Pubic Lice

Pediculosis pubis also known as the Crab Louse is a common insect infestation of the human genital area. As the infestation becomes more profound, it can also extend into other parts of the body including the eyelids. 

The louse is approximately 1 cm in size, which makes it visible to the naked eye. It has 6 legs, 4 of which have prominent pincer-like claws – much like a crab, which it uses to attach to its host. The louse feeds off its host by biting and drawing blood from the area. The lifespan of the louse is between 3 – 4 weeks, during which time, the female louse can lay as many as 80 eggs or nits. 

How do you get them?

Sexual transmission is the most common mode of transmission of the louse. Once the area has become infested with the louse, the patient will soon experience itchiness in the area. Prolonged infestation generally results in bluish bite marks in the skin. The louse requires a warm area and blood to thrive, hence they do not remain on inorganic surfaces such as tabletops and toilet seats for long. This means you do not usually get an infestation by touching such areas. 

The most at risk population are teenagers and young adults. 

How to get rid of Crabs STDs (Pubic Lice)?

The current treatment for Pediculosis pubis infestation is by topical treatment to the affected area. The aim of these treatments are to eradicate both the adult louse and nits. Although cure rates are high, it generally takes a few sessions of topical treatments to achieve complete eradication.

How to avoid getting Crabs STDs (Pubic Lice)?

The best way to prevent yourself from getting an infestation is to avoid contact with the louse. If you find out that your partner has an infestation, ensure that you clear the environment of any adult louse and eggs. Wash all fabrics such as curtains, bedding, towels and clothes with a hot cycle and a strong disinfectant. In the event you do find that you have an infestation see your doctor immediately so that treatment can be started early.

Next read: PARASITIC STIS – SCABIES

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Also on this site: hiv screening

Congenital Penile Curvature (CPC)

Congenital Penile Curvature

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

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

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

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


ESWT – Extracorporeal Shock Wave Therapy

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

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

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

Common Medical Conditions That Are Asymptomatic

Signs and Symptoms are technical terms to describe the extent of disease in a patient. A sign is an effect of the disease that can be observed by another person or elicited through certain manoeuvres while a symptom is an effect that is experienced only by the patient. 

What does being asymptomatic mean?

Being “asymptomatic” is when the patient does have the disease but does not experience any effects of the disease. In this article, we will be discussing 5 diseases where patients are usually asymptomatic in the early stages of the disease but as the disease progresses, it adds an increased burden on the body leading to more pronounced signs and symptoms.

The 5 diseases were selected because while there is no way for patients to know if they have the disease early on due to the lack of symptoms these diseases can be easily detected during health screening with your General Practitioner. Therefore, we hope to highlight the importance of your health screening in allowing your doctor to detect these diseases early and prevent the disease from progressing to a more severe state.

So just before you brush off that health screening appointment because “I feel OK” , have a read to see the benefits or early detection and treatment.


5 Diseases where patients are asymptomatic

Human Immunodeficiency Virus (HIV)

What it is?

HIV infection is a disease in which the virus attacks specific cells (CD4) in the immune system and uses the cells to create more copies of the virus, killing the host cells in the process. In the early stages of HIV, the rate of CD 4 cell production can still cope with the loss from the viral infection, therefore patients are mostly asymptomatic.

Over time as the virus replication picks up pace, the CD 4 cell numbers dwindle and the immune system becomes less effective in responding to environmental insults such as bacterial or fungal infections. Major risk factors for HIV infection include, IV drug use, unprotected casual sex and anal intercourse.

How do you test for it?

Point of Care testing can be done at most clinics in Singapore, this involves taking a sample of blood from a finger prick and placing it into a test kit. Currently, the earliest you can be tested for HIV is 30 days after infection. Early treatment of HIV prevents the virus from replicating and thus prevents the disease from worsening and progressing to Acquired Immunodeficiency Syndrome (AIDS).
HIV Testing Singapore
Anonymous HIV Testing Singapore

Chlamydia

What it is?

Chlamydia is a common bacterial infection in both Men and Women. Infection is usually found in the genital tract but also in the rectum, throat and even eyes. Up to 70% of women and 50% of men are asymptomatic. Left untreated, the bacteria can replicate further to eventually lead to an inflammatory state in the pelvis. This results in severe discomfort and particularly in women the risk of infertility is especially raised if chlamydia is untreated.

How do you test for it?

Chalmydia Rapid testing can be carried out to detect the presence of Chalmydia within 24 hours. A sample is taken from the region, a vaginal swab for women and a urine sample for men, and a Polymerase Chain Reaction is used to detect any chlamydial genetic material. Treatment of chlamydia can be as simple as a single dose of antibiotics if detected at an early stage.
Rapid STD Testing Singapore

Chronic Illnesses

High cholesterol

What it is?

Cholesterol can be thought of in 2 forms, a high density form (HDL) and a low density form (LDL). HDL lowers the total cholesterol in the body while LDL increases it. An increase in cholesterol and triglycerides (both from fatty foods) results in plaques developing within your blood vessels (Atherosclerosis). As the plaques increase in size, blood flow to your vital organs like your heart and brain are compromised thus increases the risk of heart attacks and strokes.

How do you test for it?

A blood test usually done at your health screening enables your doctor to determine the cholesterol levels in your body. Not all elevated cholesterol has to be treated with  medications because changes in diet and lifestyle can also lower cholesterol in some cases. 

Hypertension

What it is?

Hypertension is when your blood pressure is persistently elevated, the normal blood pressure should be below 140 systolic and 90 diastolic. There are myriad of causes for elevated blood pressure including, high salt intake, stress or kidney disease.

However, many people have Essential hypertension, which is when the blood pressure is found to be elevated for no particular cause. Even though the cause may not be determined in most cases of hypertension, patients with an elevated blood pressure have a higher risk of strokes. This is because, the increased pressure in the blood adds additional strain to the blood vessels, eventually, the blood vessels become weaker and are more likely to break, resulting in a stroke.

How do you test for it?

The diagnosis of hypertension in an asymptomatic patient involves a Blood Pressure diary where the patient measures her blood pressure at the start and end of the day for 2 weeks. A persistently elevated blood pressure may prompt the doctor to start treatment, however there are also non-pharmacological means of lowering blood pressure.

Diabetes

What it is?

Diabetes, in particular Type 2 Diabetes, is a condition where the body is unable to regulate carbohydrate metabolism. This results in wide spread effects on the patient because sugar derived from carbohydrate metabolism is essential to many cellular activities in the body. Although patients are mostly asymptomatic in the early stages of the disease, patients can eventually have a variety of pathologies as the disease progresses such as loss of sensation in the hands and feet, poor wound healing, reduced immunity and even blindness.

How do you test for it?

Testing for diabetes also involves a blood test to measure the sugar levels in a fasting state to gauge the current level of sugar metabolism in your body and the Haemoglobin A1c (HbA1c) which is a gauge of the long term extent of sugar metabolism in your body. Depending on the extent of your disease, treatment of diabetes can range of lifestyle modification to injectable medications.


Having a disease in its early stages sometimes means that you still feel “fine” and not experience any symptoms. However, if left untreated, these diseases can progress and lead to severe complications in your health. Getting checked regularly is essential for detecting disease in the asymptomatic phase and treating it early. This prevents the disease from progressing to a more severe state and allows us to lead better, healthier lives. Speak to your doctor today!


Other Asymptomatic Medical Conditions:

Also on this site: Wart Removal Singapore, STD Check Singapore

Swallowing Semen: What You Should Know

What is semen made of?

Semen consists of several fluids which are produced by various glands. Actual sperm cells make up only a very tiny portion of semen volume. The bulk of semen is made up of prostatic fluid, secreted from the prostate gland, seminal fluid which contains fructose, proteins and fatty acids and bulbourethral fluid from the bulbourethral glands. Semen contains protein and a multitude of other components such as fructose, citric acid, zinc, cholesterol etc. 

What is the usual color and consistency of semen?

Normal semen may have an off-white or slightly yellow tint. It is usually jelly-like in consistency, but may be slightly clumpy or more liquid in nature. But semen with a pronounced yellow or green colour may indicate an infection and a visit to your doctor is warranted. If there is blood in your semen (red or brown) please see a doctor as well.

Is semen safe to ingest?

All the components in semen are fully edible and digestible, so semen is generally safe to ingest. However, swallowing semen could prove dangerous if you suffer from a rare allergy to semen (known as “human seminal plasma hypersensitivity”), in which case you could develop a bad or potentially even life-threatening reaction. 

What happens if you swallow semen?

Swallowed semen is digested by the digestive enzymes in your gastrointestinal tract, the same as any other food which you ingest. Contrary to some urban myths, there is no risk of pregnancy from swallowing semen. 

What does semen smell or taste like?

Semen has been said to normally smell like ammonia, bleach, or chlorine due to the alkaline nature of semen. Semen can taste mildly sweet, salty or bitter. But the smell and taste can differ from person to person, and even from week to week, depending on your hydration status, hygiene, health and your recent food consumption.

However, if the semen smells or tastes abnormally strong, and is associated with discomfort on ejaculation or other urinary symptoms, it could be a sign of an infection, please see a doctor then.

Is it true that semen has dietary health benefits?

While semen does have a high percentage of protein for its weight, it is likely that you have to consume a large quantity in order for it to have dietary health benefits.

Semen also contains other components like sugar, sodium, citrate, zinc, chloride, calcium, lactic acid, magnesium, potassium and urea, but due to the small volume of semen, the dietary health benefits are likely insignificant.

Semen as a mood booster?

While there are no studies that can definitively make the link between ingesting semen and better mood, it is known that semen does contain trace amounts of endorphins, estrone, prolactin, oxytocin, thyrotropin-releasing hormone and serotonin, which can potentially affect your mood.

Rather than looking at semen as a mood booster, it is known that engaging in sexual activity in general is linked to a decrease in depression.

Will swallowing semen make you gain weight?

The amount of calories in semen is likely to be insignificant – containing less than 10 calories.

Does swallowing increase your risk of an STI?

When it comes to the risk of contracting STIs, it doesn’t matter whether you spit or swallow. Exposure to body fluids like pre-ejaculate fluid, semen, vaginal fluids or skin lesions like genital ulcers places one at risk of contracting STIs. This risk is further amplified if you have poor oral hygiene or wounds like cuts or ulcers in your mouth. 

What are the common STIs that can be transmitted through oral sex?

STIs can be transmitted through skin-to-skin contact, which includes oral-to-genital contact, or through contact with infected mucosa membranes and body fluids. Here are some of the common STIs which one may be at risk of contracting through oral sex.

Chlamydia and Gonorrhea are two common bacterial infections that can be transmitted through oral. Someone with throat Chlamydia or Gonorrhea may experience a sore throat but some individuals may have no symptoms at all and can continue to spread this infection to sexual partners. 

Syphilis can be transmitted during oral through contact with infected ulcers and if left untreated, can potentially affect multiple organs in the body including the brain and eyes.

Herpes (caused by the herpes simplex virus) can be transmitted either from an infected genital ulcer or oral cold sore or by skin-to-skin contact in an infected but asymptomatic individual. Genital herpes causes painful blisters and ulcers in the genital region. 

Human Papilloma Virus (HPV) can be transmitted as well. Some strains of HPV cause genital warts, while others increase the risk of various cancers such as cervical cancer, oral cancer or penile cancers.  

Many people tend to worry about HIV but the risk of HIV transmission through oral sex is actually extremely low, although unique circumstances like the presence or wounds or blood may increase this. 

Is it possible to be allergic to semen?

Yes. Semen allergy or seminal plasma hypersensitivity is a rare allergic reaction to proteins found in a man’s semen. While it usually affects the person exposed to it, it can also been shown to affect the person producing it.

Some common symptoms of sperm allergy are redness, swelling, pain, itching, and a burning sensation in the vaginal area. Symptoms usually start about 10-30 minutes after contact with semen. They may not be confined to the vaginal area; they can occur in any area that has contact with semen, including the skin and the mouth. Symptoms can last for a few hours or a few days.

This allergy is rare. However, if you do experience such symptoms, speak to your doctor about it.

This article is written by: Dr Grace Huang & Dr Chester Lan

Also on this site: STD check, HIV Clinic Singapore

7 Things You Need To Know About Anal Cancer In Men

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


What is Anal Cancer?

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

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


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

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

Anal Cancer In The Early Stages

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

Anal Pap Smear & HPV Testing

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

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

Treatment of Anal Cancer

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

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

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

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

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

Anal Douching – 7 Things You Need to Know!

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

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

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

Is douching necessary for Anal intercourse?

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


Are laxatives recommended when preparing for anal sex?

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


Enemas for anal douching?

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

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


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

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


Does over-douching cause you to poop?

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


How long should anal cleansing take?

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


Does anal douching increase the risk of HIV/ STDs?

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

Also read: Vaginal Douching


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Pride Month

When COVID-19 started hitting China back in Jan 2020 and in subsequent weeks, Wuhan one of the hardest-hit city in China began a lockdown that lasted for 2 months or so, few in the rest of the world stopped to think that in the following months to come, various countries would be implementing some version of the lockdown seen in Wuhan. 

As more and more countries started to close their borders and implement movement restrictions and social distancing measures in order to control the spread of the pandemic, people around the world started to realise how much as humans we value the physical interaction we have with each other. From shaking hands of friends and co-workers to holding hands of our loved ones or visiting our elderly parents and grandparents to meeting friends for a meal, we suddenly found ourselves living in an artificial bubble where all such interactions we took for granted have all but vanished in a span of days or weeks.

Singapore is no exception. Towards the end of March 2020, the government announced that Singapore would be placed in Circuit breaker mode which initially was supposed to last for a month but has since been extended to 1st Jun 2020. In a matter of days, all forms of social interaction outside an individual’s household would come to an abrupt halt. As the circuit breaker progress through time, reports from media started highlighting vulnerable groups in society which were originally marginalized under normal circumstances and made even more vulnerable with the circuit breaker rules.

Plight of groups of the homeless, jobless, foreign workers and the elderly were talked about much in the media. This pandemic has brought to surface the many groups of vulnerable populations in any society and has raised the indignation of many. As Pride month approaches, perhaps let us think about another group of vulnerable populations in the world – the LGBT+ community. The LGBT+ community around the world still faces various forms of discrimination – legal, religious, societal and in some cases their own family.

Just as many of the heterosexual couples who under the current circumstances who are unable to meet physically with each other, the LGBT+ couples are also faced with the same scenario. While one may argue that couples both heterosexuals and LGBT+ can use technology such as Zoom/ Facebook messenger to “see” each other, it is a poor substitute for being able to hold the hands of your loved ones while walking down a street or hug each other for encouragement. How many times when we feel low have we wished for friends or family or loved ones to just hold our hands or to brush that one teardrop off our face. How many times during our moments of joy have we felt to hug our friends or family or loved ones to share in that moment of joy. The LGBT+ community is no different from any other human. They too long for those moments.

Similarly, like many heterosexual individuals who are searching for love and hope to share their lives with their loved ones, the LGBT+ community is of no exception. As humans, we hope that in our short time on this Earth, we can share our joys and tears with our loved ones. To be able to wake up in the morning and see the face of our loved ones sleeping soundly and safely, to prepare meals for our loved ones. Even with the most mundane activity like grocery shopping as long as we have our loved ones beside us, we would feel the bliss of the moment. This again is no different for the LGBT+ community.

When the time comes for heterosexual couples that they are ready to move on to the next stage of the relationship, they would propose and register to become lawfully wedded couple. Similarly, for the LGBT+ community when they found the one whom they want to share the rest of their lives together, they too hope to be able to register to become a lawfully wedded couple. It is not just a symbolic gesture but also has legal implications. For example, when medical decisions have to made because for whatever reason the other partner is unable to do so, because LGBT+ couples are not legally recognized as next of kin, many times they are not allowed to make decisions on behalf of their partner and the true wishes of the other partner is not being respected. It is a heart-wrenching experience faced by all involved.

For many of the LGBT+ community, they often are faced with the prospect of “coming out” to their family or friends. The numerous nights they toss and turn in bed trying to decide whether to “come out” to their family or friends. The umpteen times when they think they have decided to “come out” but yet at the last moment could not bring themselves to do so and then subsequently beating themselves over it later. This flip-flopping is not because they are ashamed of their gender identity but rather the fear of hurting their family or losing friendships. Let all of us as friends and family and as society in general remove that fear. No one (heterosexual or otherwise) should feel fearful when they need to tell their family or friends of some news of their lives. As family or friends, we are their safe harbour.

Some may think the fear is irrational as some family or friends may think they have not said or done anything that warrants that fear. However sometimes in our daily snippets of conversation, we have evidence and subtly expressed our discrimination or disapproval of the LGBT+ community. For example, some of us may have said in the moment of anger or jest the word fag just as we would say the F- word, it may not necessarily suggest that we are discriminating against the gay community but to the LGBT+ community is another stab in their heart.

In a YouTube video featuring a gay couple who have found love with each other but found themselves unable to be legally married because while one of the partners lives in a country that just passed a law to allow for LGBT+ marriage, it comes with a restriction that if one of the partners is not a citizen of that country and is not of a citizen of a country that legalized LGBT+ marriage then they still another not allowed to be married. One of the partners in the video asked poignantly, “All we want is to get married, is it that difficult?”

With talks of how this pandemic is going to change society even when the pandemic is over, I hope that part of that change will be a greater acceptance by society of the LGBT+ community where the LGBT+ community is finally able to be allowed to love without discrimination and be accepted as being part of society. The right to love and be loved should be unconditional.

Happy Pride Month
Dr. Julian Ng

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