Men tend not to want to know about or address male reproductive diseases or diseases of the urinary tract but it is really important that they do, as it can significantly improve their health – and even save their lives. Here are some of the issues men and boys should pay special attention to; if any of these are present or suspected, you should not delay in consulting a doctor:
Undescended testis and hypospadias
At birth all boys should be checked for the presence of both testicles within the scrotum, as well as the location of the urethra (the opening that urine comes out of) at the tip of the penis. The absence of a testicle within the scrotum is called an undescended testis and poses a risk for the development of cancer of the testis later in life.
Boys are also at risk of testicular torsion, where the testicle twists on its stalk and is thus deprived of oxygen and nutrients and begins to die. This is more common during puberty. If your child has a sudden onset of severe testicular pain, typically waking him from sleep, it needs to be treated as an emergency. The testicle is potentially salvageable if operated on within six hours. The likelihood of salvage decreases sharply after this.
Males can live with a single testicle and have normal sexual function and fertility. However, it will require protection of the remaining testicle during contact sports, or the insertion of a testicular prosthesis, as it is not easy for boys to deal with the psychological and aesthetic impact of having a single testicle.
From the age of 15 to 35, testicular cancer is a risk and a potential threat to life. A simple testicular self-examination on a monthly basis can lead to early detection of testicular cancer. Feel for any hard lumps, nodules or smooth rounded masses or any change in the size, shape, or consistency of your testicles, and immediately consult a doctor.
Ritual, religious and cultural circumcisions are common in our population. When not done correctly, urologists are often called in to deal with the complications, which can be extremely severe and life-threatening.
Circumcision in the newborn stages of a boy’s life has been shown to lower the incidence of penile cancer, as has the daily washing of the area of the penis that is covered by the foreskin.
Male medical circumcision, STI/ Urethral strictures
Male medical circumcision for the prevention of HIV transmission only works when used in conjunction with the other strategies to decrease HIV rates. It does not work on its own. Risky behaviour even with circumcision will lead to high infection rates. In addition, unprotected sex leads to the transmission of other sexually transmitted infections, in particular gonorrhoea, typically known as ‘drop’, which often leads to urethral stricture disease in young men at the peak of their lives, which can impair fertility and erections.
Around the world, men’s sperm counts are decreasing. Some of the factors leading to this are known, such as endocrine-disrupting chemicals, others are not. This problem is likely to increase in the future. Men need to consult a doctor about this if there are no children born from a relationship, as too often the woman is blamed when it could be the man.
Erectile dysfunction in young men is less likely, but possible. It may be accompanied by premature ejaculation. This condition must be thoroughly assessed by a doctor without delay, as some of the causes are potentially life-threatening.
Risk of prostate cancer
At age 40, screening for prostate cancer is important, especially if you have a family history of prostate cancer and if you are African, as prostate cancer is more prevalent in the African population.
As men age they undergo a physiological change called andropause. It is the male equivalent of women undergoing menopause. Andropause is also sometimes referred to as Testosterone Deficiency Syndrome. This is due to a natural decrease in testosterone production with increasing age. This can be characterised by symptoms such as decreased libido, depressed mood and cognitive decline. Depending on the blood levels for the testosterone and the patient symptoms, it is possible to treat the patient with supplemental testosterone.
Another issue men face as they get older is enlargement of the prostate gland, called benign prostatic hyperplasia (BPH). This increase in size can decrease the diameter of the urethra, leading to various urinary symptoms such as needing to urinate more often, a feeling of incomplete emptying of the bladder, or feeling as though one cannot hold the urine. In the later stages, left untreated this could lead to the formation of urinary stones in the bladder, recurrent urinary tract infections, blood in the urine, and even kidney failure and death. Thus, symptoms of an enlarged prostate must be investigated.
Prostate cancer is the most common solid organ cancer in all males, typically in men older than 50 years. It peaks in men in their 60s and 70s. Like most cancers, if caught early, prostate cancer can be managed or cured.
Dr Kgomotso Mathabe is Acting Head of the Department of Urology at the University of Pretoria (UP) and Steve Biko Hospital. Men’s Health Month is commemorated annually throughout June.