Penile Cancer – 7 Things You Need to Know!

The mere mention of penile cancer conjures up much fear and uncertainty among public imagination, especially among grown men. It is not a common cancer in Singapore, hence it is not well known to the public. We shall explore more details in this article about this little known cancer.

What exactly is penile cancer?

Penile Cancer happens when the normal cells of the skin and tissue of the penis turns malignant and grows beyond control, forming a tumour. Penile cancer may eventually spread to other parts of the body including other glands, lymph nodes or organs.

Penile cancer is typically a disease of older men, with most patients around the age of 60 when diagnosed. In developed countries like the USA, Europe, Singapore, penile cancer is rare, accounting for less than 1% of all cancers diagnosed. This is in contrast to less developed countries like South America, Parts of Africa and Asia where penile cancer can account for 10 to 20% of all cancers diagnosed.


Signs and Symptoms of penile cancer

The majority of penile cancers arise from the head of the penis or from the foreskin. The most common findings on examination is a painless lump or an ulcer. The symptoms may include bleeding, rash or balanitis. 30 to 60 percent of patients also have swollen lymph nodes in the groin as well. 


What is the cause of penile cancer?

The majority of penile cancers are squamous cell carcinoma (SCC) and its many variants. Other cancers which can affect the penis include basal cell carcinoma (BCC), Kaposi Sarcoma (KS), melanomas and other lymphomas.


Who is at risk for penile cancer?

  • Patients with previous known medical condition of the penis. This would include warts, infections, previous injury, tears or strictures
  • Phimosis. Uncircumcised males sometimes have a thickening and scarring of the foreskin. This is a condition known as phimosis, which is a difficulty in retracting the foreskin over the head of the penis. 
  • Human Papillomavirus infection (HPV). HPV can be found in 30% to 50% of penile cancers.
  • Smoking and Tobacco Exposure
  • Human Immunodeficiency Virus (HIV) Infection
  • Patients with previous Ultraviolet treatment for psoriasis.

Who to prevent penile cancer?

  • Patients who have phimosis can consider getting a circumcision
  • Vaccination against HPV early can also be useful in preventing infection and possible penile/anal cancer. Screening for High Risk HPV through a swab can also be useful in patients who have risk factors.
  • Patients who are smokers should definitely stop smoking not only to prevent penile cancers but other forms of cancers as well.

What are the treatments for penile cancer?

Treatment of penile cancer depends on the type and staging of the cancer. If disease is limited, organ preserving treatment options include topical medications, lasers, radiation therapy or micrographic surgery. If the cancer is advanced and locally extensive, a partial or even full amputation of the penis might be required.


What are the complications of penile cancer?

After treatment, patients might be faced with complications depending on the kind of treatment. For organ preservation treatments, issues with cosmesis, erectile dysfunction and reduced sensation are common. For surgical treatments, for example a penile amputation, patients might require an external opening known as a urethrostomy for urination. Patients might also require a surgical reconstruction of the amputated organ for cosmetic issues.


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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.

Speak to our doctors today!



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.


 
 

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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Also on Dtapclinic.com: HIV Test Singapore, STD Test Singapore, Anonymous HIV Testing

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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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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Does Male Menopause Exist?

Male Menopause – Andropause

In women, menopause is the time in the women’s life that menstruation and ovulation ends as a result of decreased hormone production. It is diagnosed after a lady has not had a menstrual period in 12 months. Menopause usually occurs in a lady when she hits her late 40s or 50s, but can vary from one female to another. However, this occurs for all females eventually.

The term “male menopause” or andropause refers to age-related declining testosterone levels. In contrast with menopause where all females will eventually experience, the drop in testosterone levels may not occur in all men. In fact, a 50 year-old man can have a higher level of testosterone than say a man in his 30s. Menopause also involves a complete shutdown of reproductive capability in females, but a man in his 70s can still father a child. While it is still possible for a female to get pregnant in her 70s, it is exceedingly rare. Because of these facts, some people doubt whether male menopause truly exists. 

However, there are a few things we know. Testosterone levels can vary greatly among men but in general, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. 

Other names for this condition are testosterone deficiency syndrome, androgen deficiency of the aging male and late-onset male hypogonadism.


What are the key signs and symptoms of andropause?

The signs and symptoms of andropause is because of a drop in testosterone levels in an aging male. 

A person with andropause may experience a decline in sexual function. This might include reduced libido or sexual desire, erectile dysfunction, fewer spontaneous erections both during the day and night, and infertility. 

Some physical changes may occur, including reduced muscle bulk and strength, increased body fat, and decreased bone density. Swollen or tender breasts (gynecomastia) and loss of body hair are possible. Some may experience hot flashes. Others may report decreased energy levels. The testes might become smaller as well. 

Emotional changes may occur. Some examples include a decrease in motivation or self-confidence. Mood issues such as feeling sad or depressed may occur. Some may have cognitive issues such as trouble concentrating or remembering things. Some people may have difficulty sleeping as well. 


What are some of the aging-related hormone changes in men? Does this mean (the person) has andropause?

As mentioned above, the primary hormonal change in men is a decrease in testosterone levels. Other hormones such as growth hormone, prolactin and IGF-1 may decrease. Estradiol levels may decrease as well, but in some older males, due to increased fat mass, they may have increased estradiol levels which offsets the natural decline in estradiol levels. A hormone that tends to increase with age is the thyroid stimulating hormone (TSH). Gonadotrophin levels also tend to increase in response to dropping sex hormone levels. 

For the sake of this article, we would just be focusing on testosterone. As doctors, we do not just look at the testosterone level of the patient. We also take into account what symptoms the patient is presenting with. A gentleman may have a low testosterone level and not be bothered at all about it as it may not present with significant symptoms in him. In another gentleman, with a low-normal testosterone level may present with a whole barrage of symptoms that are affecting his life. In these 2 cases, we are more likely to diagnose and treat the second gentleman. 

It is important to note that decreased levels of testosterone may sometimes be attributed to other causes such as medications such as steroids or psychiatric medications, medical procedures such as chemo or radiotherapy, other medical conditions such as kidney conditions, tumours and hemochromatosis, inflammatory conditions such sarcoidosis, and histiocytosis, and chronic infections such as HIV and tuberculosis. Your doctor will run through your past medical history when evaluating your symptoms as well. 


Do I need treatment for andropause? 

Whether or not you need treatment for andropause depends on your symptoms, and to what degree your symptoms are affecting your work, relationships and life. 

Testosterone levels can be easily measured with a simple blood test. Other hormones and other blood tests are usually conducted at the same time. The best time to come for a blood test is in the morning when the testosterone levels are at its highest. No fasting is necessary for the blood test.

For men with truly low testosterone levels, testosterone replacement therapy (TRT) tends to result in the reversal of the symptoms mentioned above, improved quality of life and has health benefits as well.


What are the treatment options?

Lifestyle changes are always recommended for people presenting with andropause. Exercise and weight loss, stress reduction, adequate sleep and a healthy lifestyle and diet can sometimes raise your testosterone level marginally. 

In conjunction with that, we can do TRT as well, where we can replace testosterone through  pills, injections, patches or gels. The dose and frequency of delivery of testosterone varies from person to person. Doctors will usually do regular blood tests to look out for complications and to tailor the correct dose for you. 


What are the side effects and complications?

While people with true testosterone deficiency report marked improvement in symptoms, TRT is not without risk. TRT can contribute to sleep apnea, stimulate noncancerous growth of the prostate and stimulate growth of existing prostate cancer. Testosterone therapy may also increase the risk of heart attack and stroke and contributes to the formation of blood clots in the veins. It can also cause acne or other skin reactions, limit sperm production, cause testicle shrinkage and enlarge the breasts. It is therefore important to weigh the risks versus the benefits in starting TRT, and monitor for complications should any arise. 

While ageing is inevitable, andropause and its symptoms can be managed with improved quality of life as a result. Speak to your doctor to see if you do have the symptoms mentioned above and if your testosterone levels are truly low, to see if TRT is suitable for you. 


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