Phimosis and Paraphimosis

Phimosis is a condition in which the foreskin gets too tight to be pulled back over the head or glans of the penis.

It occurs in males who have not undergone circumcision (removal of the foreskin covering the tip of the penis). Phimosis resolves or improves on its own with age.

Paraphimosis is a more severe condition affecting the foreskin, in which repositioning of the foreskin to the unretracted position is not possible, and this limits the blood flow to the penis and thus causes a lot of pain and discomfort. Since it affects blood supply it is more often a medical emergency.

In adults, there are certain factors that may lead to Phimosis or Paraphimosis such as-

  1. Repeated urinary tract infections.
  2. Foreskin infection
  3. Repeated rough handling of the foreskin
  4. Sexually Transmitted Infections
  5. Certain other health conditions such as Diabetes (which predisposes one Eczema, Psoriasis, Lichen planus, Lichen sclerosis

Certain symptoms such as those below should hint on Phimosis or Paraphimosis- 

  1. Inability to pull back the foreskin*
  2. Redness, soreness, or swelling of the foreskin
  3. A tight foreskin which may interfere with the normal passage of urine and cause incomplete emptying of the bladder.
  4. Bulging of the foreskin (especially during urination)
  5. Phimosis can lead to inflammation of the penis, called balanitis, or inflammation of both the glans and the foreskin.
  6. Difficulty ejaculating
  7. Difficulty urinating
  8. Discoloration or bruising of the tip of the penis *
  9. Swelling of the tip of the penis *

The diagnosis of phimosis or paraphimosis is made by history and physical examination. Due to the sensitivity of the situation many men feel shy to discuss it with medical practitioners. However, it is very important to talk about it especially if you have any of the symptoms that have been marked with * as they may turn into an emergency.

The treatment most often depends on the cause.

Phimosis is a relatively non- emergency situation and a visit to a urologist can help. The treatment advise is based on the severity of the condition and if it has been recurring. Certain tips on hygiene and treatment for the underlying cause is given if it is non-recurrent. However, if it is serious and recurrent, the doctor may advise you for circumcision.

Paraphimosis, on the other hand, if often an emergency and painful situation which may require minor surgery.

Tips to prevent Phimosis and paraphimosis

  1. Good hygiene – Gently cleaning the penis and under the foreskin, with warm water, every day will help avoid problems. This will help in keeping the skin loose and avoiding infection.
  2. Carefully replacing the foreskin – It is important to replace the foreskin every time it is pulled back.
  3. Being sexually responsible – It is important to use condoms and practice safe sex.
  4. Take care of underlying health issues – that may give rise to either- If you are a diabetic or suffer from any condition that may give rise to recurrent urinary tract infection then it is advisable to keep a check on your underlying condition.
  5. Circumcision – Recurrent Phimosis can be prevented by circumcision.

 

Written by Dr.Afroze Fatima

https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/penis-health/art-20046175

https://www.webmd.com/men/phimosis-paraphimosis#1

https://www.medicalnewstoday.com/articles/319993.php

https://www.healthgrades.com/conditions/phimosis

https://www.drugs.com/health-guide/phimosis-and-paraphimosis.html

LOW LIBIDO IN MEN

Low libido usually indicates decreased interest in sexual activity.

It may be difficult to say if one’s low sex desire is worrisome because normally it varies between individuals, situations, various periods in life. But losing sex desire for long duration may need medical attention for a healthy life physically, mentally and emotionally. 

One in every 5 men is reported to have low sex desire according to studies. 

Sexual desire may decrease naturally as age progresses in men by about 60s and 70s.  

Testosterone is the hormone, that is normally responsible for the muscle build, bone mass, stimulation of sperm production in testicles, sex desire in men. 

Causes:

  • Hormonal changes- Low testosterone levels are the most important and the most common causes of low libido among hormonal changes. Levels below 300-350 ng/dL can be considered low. Other hormonal changes causing libido can be low thyroid hormone levels, high prolactin levels, low dopamine levels. 
  • Stress, depression.
  • Emotional disturbances, relationship issues with the partner. 
  • Medications- Antidepressants, medications for hypertension (high blood pressure) such as ACE inhibitors, beta blockers but libido may or may not be seen in all individuals taking the medications. 
  • Sleep disturbances such as inadequate sleep for less than 6-7 hours in a day, disturbed sleep, nightmares, etc. 
  • Chronic medical conditions such as cancer, Diabetes, hypertension, high cholesterol levels, obesity, etc. but may vary between individuals.
  • Frequent intake of alcohol, drug abuse such as marijuana. 
  • Age from about 60-65 years. 

Treatment:

Many men hesitate to discuss with doctor regarding decreased sex desire and other sexual health issues. However, it is important to discuss the same with the treating doctor as treatment can be very simple, most of the times.

The doctor may take history to understand if there is an underlying cause such as stress, depression, sleep disturbances, medical conditions, current medications, etc. and may advise tests to check for testosterone hormone levels in  the blood. 

  • Hormone replacement therapy of testosterone may be prescribed, if the levels are less than normal in blood. This is not needed or prescribed by the doctor, if testosterone levels are normal. 
  • Underlying medical conditions are treated with appropriate medications accordingly. 
  • Stress, depression may be treated with medications, counseling, psychotherapy, etc. Other measures, that may help can be deep breathing exercises, practicing yoga, meditation, hobbies like listening to music, reading books, going for a walk/jog in a park. Regular exercises, playing with pets, spending more time with family and loved ones, hot shower, gentle body massage with aromatic oils, getting adequate sleep of at least 6-7 hours a day, etc. may also help.
  • Medications may cause loss of libido and usually it is attributed to the starting of the medication. If that is the possible cause, the treating doctor may change it’s dose or give an alternate medication. 
  • Restricting or decreasing the frequency and amount of alcohol, abstinence from drug abuse. 
  • Getting adequate sleep of about 6-7 hours in a day.

 

References:

https://andrologyaustralia.org/your-health/low-libido/

https://www.healthline.com/health/low-testosterone/conditions-that-cause-low-libido#aging

https://www.webmd.com/sex-relationships/features/when-a-mans-sex-drive-is-too-low#1

https://www.mayoclinic.org/healthy-lifestyle/sexual-health/expert-answers/loss-of-sex-drive/faq-20058237

–   Dr. Divya Teja Pasupuleti

BENIGN PROSTATIC HYPERTROPHY

You can do a lot to take care of your health and still over the time the body ages in ways which you can’t control. One of the conditions that affects men at older age is benign prostatic Hypertrophy.

It is a common condition where in there is enlargement of the prostate leading to urinary symptoms, such as blocking of urinary flow from bladder leading to bladder distension.

Symptoms:

  • Frequent or urgent need to urinate
  • Bladder distension
  • Difficulty in urinating
  • Dribbling at the end of urination
  • Unable to completely empty the bladder
  • Urinary tract infection
  • Blood in urine

Risk factors:

  • Aging: by the age of 60 years most of the men suffer from symptoms and signs of BPH.
  • Family history: there is high chances of you getting the condition, if your father or brother is has suffered from BPH
  • Lifestyle: obese people are more prone to BPH
  • Medications: studies show that use of beta blockers may increase the size of the prostate.

Diagnosis:

Doctor would first ask you about detailed personal and familial history . Then based on the signs and symptoms would suggest below test:

  • Digital rectal examination: doctor examines by inserting the finger in the rectum to check for prostate enlargement.
  • Urine test: to rule out the urinary tract infection and other conditions which may cause such symptoms
  • Prostate Specific Antigen: it is produced by prostate and the levels are increased in case of enlargement
  • Ultrasound test: to check the size of the prostate and to look whether it’s healthy.

Treatment:

Depends on the severity and age of the patient

Medications:

Doctor may prescribe medications to relax your prostate and bladder muscles. In few cases medications are used to reduce the size of prostate.

Surgery:

Minimally invasive procedures: such as TUIP, TUMT, TUNA, and TURP.

Most common is TURP- Transurethral resection of prostate, where in a scope is inserted into urethra and the prostate is removed with the help of scope. It quickly relieves the symptoms and faster recovery is seen.

Prostatectomy: where in the entire prostrate or a part of it is removed.

 

Lifestyle changes:

Do exercises to strengthen the pelvic floor muscles

Reduce intake of fluids at bedtime or before you go out.

Drink less caffeine and alcohol.

By,

Dr.Chandrashekar

References:

https://www.medicalnewstoday.com/articles/321231.php

https://www.webmd.com/men/prostate-enlargement-bph/what-is-bph#3

https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-treatment/drc-20370093

 

Torsion testis – How is it managed and who is at risk for it?

Testes are the reproductive organs in men. Torsion of the testis is a condition where the testis spins leading to twisting of the spermatic cord. As the spermatic cord undergoes twisting due to any cause, the blood vessel to the testis (testicular artery) would undergo occlusion, decreasing the blood supply of the testis leading to testicular damage and ultimately causes death if not treated immediately.

Testicular torsion usually occurs in two different age groups:

     Neonatal period (fortunately very rare)

     Peri-pubertal period (i.e. in adolescents aged 12 to 18 years)

Risk Factors of Testicular Torsion are:

  • If someone in your family has suffered from this condition, you could be susceptible to it. Presence of the bell-clapper deformity can also lead to testicular torsion.
  • If you receive minor trauma such as the one during playing any kind of contact sports, outdoor activities or even while doing house work, it can be a reason of this condition as well.
  • Heavy exercising or running in an unbalanced or improper manner can cause torsion as well.
  • Improper sleeping positions can also cause torsion and is a common cause behind frequent torsion and detorsion.
  • Previous history of testicular pain that became alright on its own (torsion and detorsion) may increase the chances of it happening again.
  • Other factors: Excessively cold temperatures wherein the scrotum contracts rapidly and prolonged contraction can cause torsion. Fast growth of the scrotum during the adolescent years after puberty may cause torsion.

Testicular Torsion Diagnosis:

1.Physical Examination

In most cases, diagnosis is made based on the patient’s or patient’s family history and physical findings. Testicular torsion is a surgical emergency, and delaying surgery might cause irreversible damage to the testis and infertility.

2.Scrotal Doppler Ultrasound Study

In certain cases, if the pain is of very recent onset, the surgeon may order a Doppler ultrasound to check the blood flow to the testis. In torsion, the blood supply will be reduced.

However, in most cases if the pain has been there for a prolonged duration of time, the patient is directly taken up for surgery without any further delay in a bid to salvage the testis.

Management of testicular torsion:

Manual Detorsion

Testicular torsion is a surgical emergency. In some cases, the torsion might be manually corrected during initial examination, before any diagnostic imaging.

Surgery for Torsion Testis

Immediate surgical treatment is the best option to salvage the testis when torsion occurs in children or young adults.

A good history, clinical experience of the doctor and a high index of suspicion are usually the factors on which a decision is taken for performing the surgery and in most instance the surgery is done under local or regional anesthesia within 2 to 4 hours if not earlier.  

The rate of salvage of the testis is high if the surgery is done within 4 to 6 hours and drops to almost zero at 12 hours. In this procedure the testes are fixed to the posterior wall and they are preserved functionally. Its called as orchidopexy.

If the testis looks gangrenous and does not get restored after the cord is untwisted, it is best advised to be removed. It’s called orchiectomy.

Complications of Testicular Torsion:

If untreated, torsion of the testis may lead to-

  • Damage to the testis due to lack of blood flow (infarction) and its atrophy
  • Decreased fertility or infertility – reduced or absent chances of fathering children

-Dr.Bhavani Sagar Surampally

 

Enlarged male breast tissue

The enlargement of male breast tissue is known as Gynecomastia in medical terms. It is a fairly common problem and is benign. It can affect one or both breasts and can often be an embarrassing situation for males. It may be seen in newborn males, males undergoing puberty or older men.

Gynecomastia is different from pseudogynecomastia or lipomastia, which refers to the presence of fat deposits in the breast area of obese men. True gynecomastia  results from growth of the glandular breast tissue, which is present in minor amounts in men- and does not respond to exercise or weight loss.

Gynecomastia results from an imbalance in the hormones in the body, with a relative excess of oestrogens (female hormones) when compared to androgens or testosterone (male hormones).

Certain medications (like antibiotics, anti-anxiety drugs, antacids, Anabolic steroids)  health conditions (like thyroid issues, liver failure, renal failure) or intake of certain products (like soy, Street drugs , alcohol,) may also result in this problem.

If the gynecomastia happens during puberty, it may go on its own. However, if it happens later on in life, it mostly requires medical intervention.

After a careful evaluation of the breast, and differentiating between true gynecomastia and lipomastia, you may be advised by your doctor to-

  1. Try weight loss
  2. Visit an endocrinologist to get your hormones assessed.
  3. Treat the underlying cause

And if none of the above work, treatment options, including medication and surgery are explored.

Many men suffer from it and face teasing and the disapproval of peers. The problem of gynecomastia is very common and embarrassing but the good news is that it can easily be corrected. It is highly advisable to reach out to a physician if you or any of your family members suffer from this.

By,

Dr.Afroze Fatima

https://www.webmd.com/men/what-is-gynecomastia#1

https://www.webmd.com/men/news/20070919/male-breast-enlargement-may-be-common#1

https://www.mayoclinic.org/diseases-conditions/gynecomastia/symptoms-causes/syc-20351793

https://www.mayoclinic.org/diseases-conditions/gynecomastia/diagnosis-treatment/drc-20351799

https://www.mayoclinic.org/diseases-conditions/gynecomastia/multimedia/gynecomastia-enlarged-male-breast-tissue/img-20007324

https://www.mayoclinic.org/diseases-conditions/gynecomastia/multimedia/gynecomastia-enlarged-male-breast-tissue/img-20007324

 

Patchy beard (Alopecia Barbae)

It is a specific form of Alopecia areata which usually affects beard. It is a autoimmune disease which affects hair follicles. The exact cause of alopecia areata is unknown, but it seems to be caused by the immune system attacking the hair follicles by mistake. It’s a sudden onset of losing  beard hair in small circular patches, often seen along jawline. It can be isolated to the beard or sometimes it may even occur in scalp or face. Exact cause is not known, but psychological and physical stress are linked to it. Increased risk in case of family history of autoimmune diseases. Some medications and viruses can trigger the condition.  Itching and pain can be felt at the area of hair loss.

Blood test and scalp biopsy may be needed to diagnose the signs of infection or the underlying cause. But most of the time based on the way it looks and the pattern of hair loss, dermatologist will diagnose it. Other tests to rule out fungal infections and thyroid disorders are advised.

There is no cure for Alopecia Barbae, but the symptoms can be controlled. People with mild early alopecia areata may need no treatment, as their hair is likely to come back anyway without it. With treatment hair may grow back, but there is no guarantee that it won’t fall again. Treatment always depends on the age, hair loss you have and the underlying condition. If there is very extensive hair loss from the start, the chances of it regrowing are not as good. Any treatments that carry serious risks should be avoided, as alopecia barbae itself has no adverse effect on physical health.

Some other options are:

» Topical steroid creams or ointments
» Steroid injections into the bald patches
» Contact sensitizers, such as squaric acid or DPCP(Diphencyprone)
» Other topical medications, like anthralin or minoxidil

References:

https://www.healthline.com/health/alopecia-barbae#Treatments

https://en.wikipedia.org/wiki/Alopecia_areata

By,

Dr. Y. Alekhya

 

Premature Ejaculation

Ejaculation is the release of semen from the body. Premature ejaculation (PE) is when ejaculation happens sooner than a man or his partner would like during sex. Occasional PE is also known as rapid ejaculation, premature climax or early ejaculation. PE might not be a cause for worry. It can be frustrating if it makes sex less enjoyable and impacts relationships.  It may result in unsatisfactory sex for both partners. This can increase the anxiety that may add to the problem. It is one of the most common forms of male sexual dysfunction.

If premature ejaculation happens infrequently, it’s not cause for concern.

You might be diagnosed with premature ejaculation if you:

  •         Always or nearly always ejaculate within one minute of penetration
  •         Are unable to delay ejaculation during intercourse all or nearly all of the time
  •         Feel stressed and frustrated, and tend to avoid sexual intimacy as a result.

When to see a doctor

It’s common for men to feel embarrassed about discussing sexual health concerns, but don’t let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem. Your doctor will discuss your medical and sexual history with you. He will do a thorough physical exam. Your doctor may want to talk to your partner also. Premature ejaculation can have many causes. So your doctor may order lab tests to rule out any other medical problem.

Common causes-

  1. Emotional and psychological factors –

 

             Stress

             Depression

            Performance anxiety

             Early sexual experiences

             Sexual abuse

             Poor body image

             Worrying about premature ejaculation

              Guilty feelings that increase your tendency to rush through sexual encounters

  1. Erectile dysfunction (ED)- Erectile dysfunction is when the penis does not remain        firm enough for sex. Men who are worried they could lose their erection may develop a pattern of rushing to ejaculate.
  2. Anxiety.
  3. Relationship problems.

How Is It Treated?

Ninety-five percent of men are helped by behavioural techniques that help control ejaculation.

Stop and start: You or your partner stimulate your penis until you feel like you’re going to have an orgasm. Stop the arousal for about 30 seconds or until the feeling passes. Start the stimulation again and repeat three or four more times before you actually ejaculate.

The Squeeze: It works the same way as the start and stop method. But, when you feel like you’re reaching orgasm, you or your partner squeezes the head of your penis very gently until you lose the erection. Repeat this a few times before ejaculating.

Some men find that if they think of something else during sex they can last longer.

Pelvic floor exercises in males

Weak pelvic floor muscles might impair your ability to delay ejaculation. Pelvic floor exercises (Kegel exercises) can help strengthen these muscles.

Condoms

Condoms might decrease penis sensitivity, which can help delay ejaculation. “Climax control” condoms are available over the counter. These condoms contain numbing agents such as benzocaine or lidocaine or are made of thicker latex to delay ejaculation.

Psychological Therapy

Therapy is a way to address the negative feelings and emotions that lead to problems with sexual relationships. Psychological therapy can be used as the only treatment, or it may be used along with medical or behavioural therapy.

With the simple techniques listed here, about 95 out of 100 men will recover from PE. There is no way to promise recovery, but learning how to relax helps. If the problem remains, continue to work with your healthcare provider to find solutions.

-Dr Prerna Gaur

Acknowledgements-

https://www.urologyhealth.org/urologic-conditions/premature-ejaculation

https://www.mayoclinic.org/diseases-conditions/premature-ejaculation/diagnosis-treatment/drc-20354905

https://www.webmd.com/men/what-is-premature-ejaculation#2