7 Different Types of Eczema

Eczema is an uncomfortable condition where parts of the skin become itchy, rough, inflamed, and in worst cases, ooze puss. Characterized by red patches and blisters, they are a great discomfort and are projected to plague a number of people in our population.

In this article, we will go over the various types of Eczema, their symptoms, and their causes in order to help you understand how to best prevent getting them. 


Different Types of Eczema


1. Stasis Dermatitis 

What is Stasis Dermatitis? 

Occurs usually in the lower leg, it is the formation of rough dry patches. It makes the leg feel heavy and inflamed. Stasis Dermatitis can also be known as Venous Dermatitis or Venous Eczema. 

What are the symptoms of Stasis Dermatitis? 

• Patches of skin colored yellow, red, or brown. 

• Bulging veins and swelling of the leg. 

• Itchiness and inflammation. 

• Sores that ooze. 

• Ulcers. 

What are the causes of Stasis Dermatitis? 

Usually found in individuals over 50 years of age or above, the condition is brought about by low circulation of blood to the leg. Usually due to high cholesterol or injury preventing proper blood flow. 

2. Nummular Eczema 

What is Nummular Eczema? 

Also known as Nummular Dermatitis or Discoid Eczema, these are characterized coin-shaped lesions that appear on the arm and legs that may or may not ooze puss or clear liquid. 

What are the symptoms of Nummular Eczema? 

• Circular lesions on the skin 

• Dry and itchy 

• Blisters that ooze liquid or puss 

What are the causes of Nummular Eczema?

There are no known definitive reasons why Nummular Eczema forms. It is thought that it is a congenital condition that forms when the individual is injured or experiences drastic changes in temperature. It may also be an allergic reaction to certain soaps or skin products. 

3. Neurodematitis 

What is Neurodematitis? 

Typically found on the neck, wrists, arms, legs and anal region, it is known for causing extreme itchiness that will worsen if scratched – creating an uncomfortable itch-scratch cycle. 

What are the symptoms of Neurodematitis? 

• Itchy Patches 

• Scaly textured skin 

• Patches that are rough and differently colored to the rest of the skin. 

What are the causes of Neurodematitis? 

A chronic skin condition, it is generally thought to form through bug bites or tight fitting clothes. There is, however, no objectively proven reason for their formation.

4. Hand Eczema 

What is Hand Eczema

Also known as hand dermatitis, it is blisters and red patches in the hands that are thought to be caused by allergic reaction or genetics. 

What are the symptoms of Hand Eczema? 

• Red Patches on the hands 

• Blistering 

• Dryness and flaking 

• Itchiness and pain 

What are the causes of Hand Eczema? 

Likely caused by allergic reaction to irritant substances. It is also known to come seasonally for those who possess it genetically. 


5. Dyshidrotic Eczema 

What is Dyshidrotic Eczema? 

Also known as Pompholyx, it is a form of dermatitis that forms on the tips of fingers, soles of feet, toes, and palms. Such a skin condition can sometimes be unresponsive to treatment and can cause much burden to both patient and doctor. 

What are the symptoms of Dyshidrotic Eczema? 

• Blistering and scaliness 

• Clear, white, or yellow colored patches 

• Itchy and may exude clear liquid 

What are the causes of Dyshidrotic Eczema? 

It may be caused by stress, pollen, excessive sweating, and/or an allergic reaction to nickel in jewelry or other metals. 


6. Contact Dermatitis 

What is Contact Dermatitis

It is the red and itchy patches of skin caused by direct contact to substances which one is allergic to.

What are the symptoms of Contact Dermatitis?

• Red rashes 

• Bumps caused by severe scratching 

• Itchiness 

• Tenderness, swelling, or burning sensation of the skin. 

What are the causes of Contact Dermatitis? 

The likely culprits are cosmetic products, soaps, and/or cleaning chemicals that cause irritation and allergic reactions.


7. Atopic Dermatitis 

What is Atopic Dermatitis? 

Long lasting and tends to flare up in periodic time frames, it is characterized by red itchy patches and may be accompanied by fever or asthma. There is no known cure. 

What are the symptoms of Atopic Dermatitis? 

• Dry Skin 

• Red Patches or Bumps 

• Itchiness and swelling 

• May be crusty and leak 

What are the causes of Atopic Dermatitis? 

Perhaps caused by an allergic reaction to certain foods, it is likely a genetic condition spurned by a lack of moisture on the skin thus making it more prone to irritants. 

We provide testing, treatment and management for Eczema and other skin conditions at our DTAP Clinic @Orchard.

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Parasitic STIs – Scabies

Scabies are one of the more uncommon STIs (Sexually Transmitted Infections) present in Singapore. As it is rarely seen in a clinic setting and the signs are often unremarkable, it can be easily missed by both patient and the doctor. So what exactly is scabies? We will talk about it in a little more detail and how it is relevant to you and your sexual health.

Scabies – The hidden itch

Scabies are not an infection, but an infestation of microscopic mites, Sarcoptes scabiei. These tiny eight-legged creatures live within the human skin. After mating, female mites will burrow through the epidermis causing skin damage and lay eggs within the burrows. Larvae, after hatching, will grow and continue the whole lifecycle. 

Signs and Symptoms

These burrowing caused by the mites do not actually cause pain, but the allergic reaction to the mites, faeces and eggs leads to an intense itching that is typically worse at night. The itching starts 3 to 6 weeks after initial infestation. 

The typical physical finding is a extremely itchy pimple-like rash in areas such as:

  • Between fingers
  • Armpits
  • Wrist
  • Elbow
  • Genitalia
  • Waist
  • Buttocks

The back and the head are typically spared, except in very young infants.

Another more serious variant is Norwegian Scabies. This happens in patients with compromised immune systems, for example patients with HIV, lymphoms or long term steroid use. The mites will form deep, scaly rashes which are highly infectious.

How does one get it?

Scabies can be spread through direct and prolonged skin to skin contact, for example between family members or sexual partners. Casual contact is highly unlikely to spread scabies. 

Scabies can also be spread through indirect contact. As the scabies mites can survive up to 36 hours off a host, they can be indirectly transmitted through sharing clothes, bedding, towels with an infected individual. 

To prevent scabies, avoid skin to skin contact with infected individuals and do not share clothes and bedding. Condoms are NOT useful in preventing transmission as scabies spread through direct contact and not through body fluids and secretions.

Treatment options

Thankfully, scabies can be treated. A topical preparation known as Permethrin can be applied as a single dose to the whole skin from scalp to toe. Commonly, a single application is sufficient for eradication of scabies. An antiparasitic agent known as Ivermectin can also be given orally for eradication with good effect. To prevent re-infection, all contaminated clothing and bedding should be thoroughly laundered with hot water.

In conclusion, if you find mysterious pimple-like rashes which are intensely itchy after an exposure, see your doctor for further advice! 

Next read: CRABS STDS – PUBIC LICE

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Neurosyphillis

Syphilis is a Sexually Transmitted Infection (STI) caused by the bacteria Treponema Pallidum. It is a systemic infection with a multitude of signs and symptoms depending on the stage of the infection. As such, syphilis is also known as “the Great Imitator” because the clinical presentation may appear similar to many other diseases.

There are four stages of infection: 

  1. Primary syphilis – painless ulcer (or chancre) at the site of infection
  2. Secondary syphilis – manifestations that include, but are not limited to, skin rash, mucocutaneous lesions, and lymph node swelling
  3. Latent syphilis – this stage can last for a number of years with few or no symptoms
  4. Tertiary syphilis  – gummatous lesions (soft, non-cancerous growths), neurological problems, or cardiac symptoms

In this article, we will focus on neurosyphilis. You can learn more about syphilis as an overall topic in a previous article:



What is Neurosyphilis?

Neurosyphilis occurs when the infection reaches the central nervous system i.e. the brain or spinal cord. Neurosyphilis can occur at any stage of infection, but tends to occur in tertiary syphilis. Therefore, neurosyphilis can occur within a few months, but could also develop after 10 to 30 years, of a syphilis infection. 

There are four different forms of neurosyphilis:

  1. Asymptomatic (most common form)
  2. Meningovascular
  3. General paresis (muscle weakness)
  4. Tabes dorsalis (slow degeneration of the neural tracts of the spinal cord)

Asymptomatic neurosyphilis occurs before symptomatic neurosyphilis. Early neurosyphilis affects the blood vessels and meninges (membranous coverings of the brain and spinal cord) whereas late neurosyphilis affects the brain and spinal cord itself.

Signs & Symptoms

Signs and symptoms vary widely depending on the form of neurosyphilis, including:

  • Stroke
  • Changes in personality
  • Dementia, mania, or paranoia 
  • Ataxia (loss of coordination of muscle movements, eg. leading to gait abnormality)
  • Ophthalmic symptoms (eg. blurred vision, reduced color perception)
  • Urinary symptoms (eg. bladder incontinence)
  • Headache
  • Giddiness
  • Hearing loss
  • Seizures 
  • Hyporeflexia 
  • Sensory impairment 

Risk Factors

The risk factors include: 

  • High risk sexual behaviour from unprotected sex and multiple sexual partners
  • Men who have sex with men
  • Recreational drug use

Diagnosis

Syphilis is diagnosed either via blood tests or direct visual inspection using dark field microscopy. In practice, blood tests are more commonly used as they are easier to perform.

To diagnose neurosyphilis specifically, cerebrospinal fluid (CSF), which is a fluid surrounding the brain and spinal cord, is obtained via lumbar puncture and the Venereal Disease Research Laboratory (VDRL) test is performed on the CSF. 

Other laboratory investigations that may be performed include: cerebral angiogram, computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain, brain stem or spinal cord.

Treatment

Syphilis is treated with intramuscular injection of the antibiotic benzathine benzylpenicillin. Early syphilis is treated with a single dose whereas late syphilis is treated with a once-weekly dose for 3 weeks. 

For neurosyphilis, however, the treatment course is different as penicillin penetrates the central nervous system poorly. Instead, the treatment requires intravenous penicillin every 4 hours for 10 to 14 days.

Generally, follow-up blood tests are performed at 3, 6, 12, 24, and 36 months to ensure the infection has fully resolved. Follow-up lumbar punctures for CSF analysis are performed every 6 months. 

Prevention

Neurosyphilis can be prevented with the following measures:

  • Safe sex practice, namely correct and consistent condom usage
  • Avoiding high risk sexual behaviour. Aside from abstaining from sexual contact, the surest way of avoiding STIs is to be in a mutually monogamous relationship with a partner who has been tested and is free of STIs
  • Regular STI screening and if syphilis has been detected, to receive early and prompt treatment
  • In the case of an individual diagnosed with a syphilis infection, prompt partner notification and treatment helps to reduce the risk of undetected syphilis

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“Cheap” Viagra

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

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

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

Image taken from Immigration & Checkpoints Authority Facebook.


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

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

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

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

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

2. You could be paying for a dud

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

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

3. You have no idea how these drugs are made

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

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

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

ESWT For Erectile Dysfunction

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

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

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

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

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


Phototherapy

What is Phototherapy?

Phototherapy is the treatment of skin diseases with light, commonly using ultraviolet (UV) light.  UV light is that invisible part of sunlight with wavelengths shorter than visible light. The history of phototherapy dates as far back as ancient Egypt, where natural light was used in combination with herbal extracts to treat skin diseases.

The UV spectrum is classified into 3 wavelength ranges – UVA, UVB and UVC – in descending order of wavelengths.  UVA and UVB are used in medical treatments. UVA penetrates deeper into the skin and is more often associated with skin aging.  It is the most abundant form of UV rays in sunlight that reaches the earth surface.  UVB is associated more with sunburns.

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How does Phototherapy work ?

Phototherapy has the effect of reducing skin inflammation and promoting growth of pigment cells in the skin.  Hence it is especially well suited for the treatment of vitiligo and inflammatory skin conditions like psoriasis and eczema. 


What skin diseases can Phototherapy treat ?

Skin conditions that have been effectively treated with phototherapy include:

  • Vitiligo
  • Psoriasis
  • Atopic dermatitis also commonly known as eczema
  • Nodular prurigo
  • Pityriasis rosea
  • Pityriasis lichenoides chronica
  • Lichen planus
  • Chronic spontaneous urticaria
  • Progressive macular hypomelanosis

How is treatment like ?

Phototherapy can be delivered either to the whole body or only to a certain part of the body.  The machines used are different in each case.

Whole body phototherapy is conducted in a stand-up position inside an enclosed treatment booth. The inner walls of the treatment booth are lined with UV lamps all around for a uniform whole body treatment.  This is the most common form of treatment and is suitable for skin diseases that involve a large proportion or span across different parts of the body.

Targeted phototherapy on the other hand, is delivered via a handheld UV lamp operated by a therapist. This form of phototherapy treats only the affected parts of the skin and spares normal skin from unnecessary UV radiation.  It is suitable for treatment of skin diseases affecting only a small part of the body.

In whole body phototherapy, the initial treatment time is brief, usually less than a minute.  This time will gradually increase in subsequent sessions as the skin becomes used to the effects of treatment such that a higher dose of UV light will be required to maintain effective treatment effects.

Treatment times for targeted phototherapy will depend on the amount of skin area to cover in one treatment session. Treatments are usually carried out 2 to 3 times per week for several weeks and sometimes several months in order to see significant improvement in the skin conditions treated.

The number of treatments needed to achieve satisfactory clearance of skin disease is variable and depends on several factors like the type of skin disease being treated, duration of disease, area of the body affected, sensitivity of the skin to UV therapy and others.  Consistently following a regular treatment schedule is usually key to successful therapy.

Once satisfactory clearance of disease has been achieved, maintenance phototherapy once a week or fortnight may be recommended to prevent relapse.

Phototherapy may sometimes be combined with certain oral medication and/or topical creams to enhance treatment effects and success.


Is Phototherapy safe ?

Phototherapy is generally a very safe method of treating skin diseases.  It is an externally applied treatment that does not harm the internal organs compared to certain oral medications that are used to treat skin diseases.

The actual treatment is generally painless.  The most common potential side effects are sunburn, redness of the skin, itchiness and dryness that are easily relieved with frequent application of a moisuriser. Very rarely, severe sunburn can develop that requires medicated creams for treatment.

A tan may also develop after prolonged phototherapy.

The eyes and skin of the male genital organs can be susceptible to damage from UV radiation.  Hence it is important to shield those areas during phototherapy with UV protective goggles and underwear.  Doing so can prevent such risks.

It is possible with any form of UV light that an increased incidence of skin cancer may occur later in some patients, usually only after many UV light treatments.  This risk is minimal in short-term therapy.  Studies to date have not shown association of narrowband UVB phototherapy with increased skin cancer.

Skin aging is another side effect of long-term therapy.


How do I know if I am suitable for Phototherapy ?

Your doctor will ask about your medical history and the medications that you are currently taking before advising if you are a suitable candidate for phototherapy.  Certain medical conditions such as systemic lupus erythematosus can be made worse by phototherapy and if you have such a medical condition, you may not be suitable for phototherapy.  Certain medicines can make you more sensitive to UV light or sunburn easily.  If the medicine that you are taking have this concern, then adjustment to dose or time of taking the medicine may have to be made before phototherapy.

Phototherapy is usually recommended as the next step in treatment if medicated creams are no longer working for your current skin condition.

Phototherapy is available at our DTAP @Orchard Clinic, if you have any question or would like to find out more about phototherapy and how this safe and potentially beneficial treatment method can help manage your skin disease.

Next read: Vitiligo Causes, Signs & Symptoms

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What happens if you tear or injure your Frenulum?

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


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

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

Common causes for Frenulum injuries/ tear

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

How long does it take for it to heal?

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

Treatment options

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

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

How do I avoid getting a Frenulum injury/ tear?

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

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

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

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

 

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


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Can I get an STD from a hand job?

This is a very common question that I get from patients who come to see me. Some are worried about contracting STDs when giving or receiving hand jobs or masturbation from another person. Generally speaking, there is very little risk of contracting STDs from a hand job.

Even though it is low risk, it is still not zero risk. Let me share with you some points about hand jobs and STDs.


You getting the hand job VS when you’re giving the hand job

Generally hand jobs have very low risk of transmission of STDs. However, if you give the hand job, you are at lower risk of getting an STD as compared to when receiving one. Why is that? STDs tend to affect genitals more than our hands. So if you are at the receiving end, it is your genitals that are at risk. If you are giving the hand job, it is less likely for you to get STDs unless you touch your own genitals after giving the hand job.


Type of STDs that might be transmitted through a hand job

Not all STDs are transmissible via handjobs. It is usually the ones that are passed on through skin to skin contact that are transmissible.

These include: 

  • Herpes Simplex Virus (HSV) Type 1 and 2. This usually causes painful sores or vesicles around the lips or genital areas. There is no cure for the virus but you can take antiviral medication when the symptoms appear to reduce the duration and severity of the symptoms.
  • Human Papilloma Virus (HPV): This virus usually causes genital warts. Warts are flesh coloured growths on the skin. There is also no treatment to treat the virus but there are different types of treatment available to remove the warts when they appear.
  • Molluscum Contagiosum: This is causes by a virus that lives on the skin. It can also be spread via skin to skin contact. It appears as small firm bumps on the skin which are generally harmless and painless. They usually go away on its own or you can get it removed by a doctor through freezing or laser removal.

How can you prevent it? What is considered “safe sex”?

As how we advise for all STDs, abstinence is best. 

Avoid multiple partners. Keeping to one partner minimizes the risk of STDs.

Avoid high risk exposure from sex workers or those who work in massage parlours. These workers have high exposure to several people a day so you will be at higher risk.

Condoms: Condoms may provide some protection. However do take note that areas not covered by the condom is still at risk of STDs.


Get tested to be sure!

If you’re ever in doubt, or unsure of your risks and or symptoms, do seek medical advice. The doctor will be able to advise if you need to get tested or get treated.


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Delayed Ejaculation/ Inability To Ejaculate (Male Anorgasmia)

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

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

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

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


Causes of Male Anorgasmia

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

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

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

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

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

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

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

Diagnosis of Male Anorgasmia

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

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

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


Treatment options

Treatment will depend on the underlying pathology. 

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

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

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

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

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

Next read: Premature Ejaculation


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Why Is My Semen Green Or Yellow?

Here’s a guide to unusual semen colours and when you should be concerned. 

The quality of a man’s semen is a maker of their overall health. So the next time after sex/masturbation, it might be worthwhile to take a glance at the condom/kleenex before disposing of it. Who knows, you might just detect an underlying medical condition by yourself!


Colour of semen is White, Clear or Grey

Normal semen is a whitish, cloudy even greyish fluid with the consistency of egg whites.


Colour of semen is Yellow or Green

#1 Medications/Supplements

Certain medications and supplements will tint the semen yellow. This is usually not a problem as the colour is caused by the by-product of the metabolism of the medication. Common medications include rifampicin, an antibiotic which can stain the semen yellow or orange and metronidazole which can turn the semen brownish. Other common medications are senna, a commonly used laxatives and Vitamin B supplements.

#2 Urine in the semen

Urine and semen travel through a common tube, known as the urethra. In cases of urinary retention, when urine is left behind in the urethra, semen can be mixed with urine giving rise to yellow urine.

#3 Jaundice

Jaundice is a condition where there is a build-up of bilirubin from red blood cell destruction. Other than staining the semen yellow, patients also do find yellowing of their skin as well as the whites of their eyes. The other symptoms of jaundice also include abdominal pain, nausea/vomiting

#4 Leukocytospermia

Leukocytospermia happens when too many white blood cells are present in the urethra. This can happen in the setting of an infection, for example a sexually transmitted infection like gonorrhea or chlamydia. Leukocytospermia can also happen in a prostatic infection causing a yellowish-green semen. Other symptoms of prostatitis includes difficulty in urination, pain on urination/ejaculation, pain near the rectum, fever. 


Pink/Red

#1 Fruits and Vegetables

Consuming beetroots and red dragon fruits can give semen a pinkish-reddish tinge. 

#2 Hematospermia

Hematospermia refers to blood in the semen. It’s an alarming phenomenon but studies have suggested that the majority of hematospermia are benign. It is almost never a sign of cancer in younger patients.

The most common cause of hematospermia is after a procedure for example after a prostate biopsy. It will last for 3 to 4 weeks with spontaneous resolution.

Uro-genital infections and prostatitis can also lead to reddish urine by irritating the lining of the urinary tract and causing bleeding. Other associated symptoms are pain with urination or pus discharge. Once diagnosed and treated, resolution of reddish urine is common. 

However, if hematospermia is persistent for more than a month and the patient is more than the age of 50, it is still advisable to see the doctor for prostate cancer evaluations.

Also read: WHAT IS HEMATOSPERMIA (BLOOD IN SEMEN)?


Black/Dark-coloured

#1 Hematospermia

Black semen is likely old blood in the semen that has been in the body for a long time. 

#2 Heavy Metals 

High levels of heavy metals, such as lead, manganese and nickel in the blood can lead to dark coloured urine. This is important for workers in related industries who might have possible exposure.

#3 Spinal Cord Injury

Patients with previous spinal cord injuries are known to have brown coloured semen on at least one ejaculation.  

There are still many other causes that can lead to discolouration of semen. If you have any particular concerns or any symptoms, it’s best to see your healthcare provider for advice.

Next read: ANAL WARTS: WHAT YOU HAVE ALWAYS WANTED TO KNOW, BUT WERE TOO EMBARRASSED TO ASK.


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Anal Warts: What you have always wanted to know, but were too embarrassed to ask.

Anal warts are definitely not a topic for polite conversation. As an affliction upon one of the more intimate parts of the human body, patients frequently have multiple concerns regarding cosmetic appearance, stigmatization, personal health and sexual relationships. It is also not commonly brought up to their spouses or doctors. We are here to find out more about this extremely common condition and dispel common misconceptions about it.


What are Anal Warts?

Anal warts are common skin growth around or inside the anal canal caused by a virus known as the Human Papillomavirus (HPV). They come in all shapes and sizes, ranging from a small pinhead-like growth to big cauliflower-like lesions. They usually do not cause patients much pain or discomfort and patients might not be aware that anal warts are present because of the nature of the location


What is HPV and how is it spread?

HPV is the most common sexually transmitted disease (STD) in the world. It is a family of viruses with more than 200 types. They are typically divided into low-risk and high-risk types based on associated risk for cancer in any body areas. The low-risk types HPV 6 and/or 11 are detected in around 90 percent of anal warts.

HPV is transmitted through contact with infected skin. Anal HPV infection is almost always acquired through sexual contact. Anal warts by themselves are not required for transmission but are highly infectious.


Common myths about anal warts

Myth #1 – My partner has anal warts, he/she is cheating on me!

This myth is responsible for a great deal of anxiety and anger. HPV infection can lie dormant in the body for months and years before causing anal warts. There is no way to find out when the infection was acquired. 

Myth #2 – Anal warts can lead to anal cancer.

Anal warts are almost always benign. They are caused by low-risk HPV types 6, 11, 42, 43 and 44 and do not develop into cancer. 

Myth #3 – HPV is incurable, and recurrence of anal warts are common.

It is indeed true that there is no known cure for HPV. However, warts and precancerous lesions can be easily treated when detected. Recurrence of anal warts is not a given, and some patients might find recurrence getting less frequent and eventually stopping with time. 

Myth #4 – Condoms use during sex will prevent HPV transmission

Unfortunately, that is not the case. Condom use will prevent transmission of pathogens such as HIV and syphilis that are spread through bodily fluids. They are not so effective against other pathogens such as herpes or HPV as they are spread through skin-to-skin contact. This is because condoms do not cover the entire external genitalia.

Nonetheless, condom use can still lower the risk of HPV transmission and other STDs. They still play an important role in sexual health and STDs prevention strategies. 


Diagnosis of anal warts

Diagnosis of anal warts is normally done at the doctor’s office clinically through a thorough history and physical examination. The majority of anal warts do not require a biopsy for diagnosis.

HPV screening for anal warts is not routinely recommended. This is because all commercial laboratories will only test for high-risk HPV types and not low-risk HPV types that causes anal warts.


Treatment

Anal warts treatment depends on the size, number, site as well as patient’s preference.

Home treatment with preparations such as Imiquimod cream or Podofilox solution are available. However, they are limited in utility due to the locations of the warts which might not be easily reached by the patient. 

Cryosurgery is the use of extremely low temperature through liquid nitrogen to destroy the abnormal anal wart cells. It can be done as an office procedure but will require multiple cycles for treatment depending on the size of the warts.

Radiofrequency ablation is a procedure in which heat, which is generated through an electric current, is used to destroy the abnormal anal wart cells. It can also be done as an office procedure. An injectable pain-killer is commonly given before the procedure to numb the area and commonly a single session will be sufficient for anal warts removal.

Finally, if the anal warts are too large or too extensive, surgical excision under general anasthesia might be considered by a surgeon. 


Prevention 

By observing safe sexual practices such as use of condoms during sex and limiting the number of sex partners, patients can reduce their chance of contracting HPV.

A vaccine (Gardasil 9) is available for males and females to prevent ano-genital warts but it will not treat existing HPV or ano-genital warts. This vaccine can prevent most cases of genital warts in persons who have not yet been exposed to wart-causing types of HPV.

Next read: WHY IS MY SEMEN GREEN OR YELLOW?

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