Men’s Health, an area of medicine that recognizes that certain medical conditions are either unique to men or are much commoner in men than in women. Although it is not a formal field of medicine, like gynaecology, it is arousing a growing interest among the public, particularly in the wider aspects of men’s health, such as heart problems (which are more common among men than women).
II DISORDERS OF THE MALE REPRODUCTIVE SYSTEM
In medicine, male reproductive disorders are generally covered by the specialities of urology, endocrinology, and genito-urinary medicine (formerly known as venereology—see Sexually Transmitted Diseases).
A Prostate Enlargement
Prostate gland enlargement appears to be an almost inevitable effect of ageing. About a quarter of men over 65 have moderate to severe symptoms of this condition. Enlargement interferes with the flow of urine from the bladder by narrowing that part of the urethra that passes through the prostate gland. The result is a reduction in the force of the urine stream and an inability to empty the bladder completely. This causes increased frequency of urination, most noticeable by the repeated necessity to get up at night. If the prostate enlarges greatly, acute stoppage may occur—a painful emergency situation urgently needing the insertion of a catheter (tube) to drain away the urine.
The treatment of prostatic enlargement is to remove part or all of the gland. This is most commonly done through the urethra, using a special viewing and cutting instrument known as a resectoscope. The results are generally excellent. Various drugs can also be used to shrink the gland, but these are far less effective than surgery.
B Prostate Cancer
At the beginning of the 21st-century cancer of the prostate was the most common cancer in men in the UK and the United States, and is on the increase in younger men. In 2000 almost 22,000 cases were reported in the UK, with about 10,000 deaths. The immediate symptoms are similar to those of simple enlargement, but the implications of the disease are usually far more serious. Spread of cancer to the bones, lungs, and other parts are common. Treatment involves removal of the prostate and elimination of the male sex hormones, such as testosterone, on which prostate cancer is dependent. This may involve castration or the use of female sex hormones. Because of the possibility of cancer, men who suffer any obvious problems with urination should always report it for medical investigation. In recent years the introduction of a simple blood test (the prostate-specific antigen test) has allowed the detection and treatment of cancer at an early stage.
Inflammation of the prostate gland is fairly common. It produces symptoms similar to those described above, but with fever, pain, and severe burning discomfort on urination. Treatment with antibiotics is effective and usually restores normal urinary function. See also Prostatitis.
D Penile Disorders
Penile disorders are relatively uncommon, but men sometimes have problems with a tight foreskin (prepuce) which, when retracted, cannot be replaced. This distressing condition, known as paraphimosis, is liable to affect men with an unusually narrow outer opening in the prepuce. Paraphimosis can be avoided by circumcision. Cancer of the penis is very rare. The best prevention is good personal hygiene with daily washing under the foreskin.
Peyronie’s disease is a modular contraction in the part of the fibrous sheath surrounding the erectile tissue of the penis that causes angulation on erection. The penis is unable to enlarge uniformly as it fills with blood, and bends upwards or to one side. Sexual intercourse may be impeded or painful for both partners. The cause is unknown, so no preventive measures can be recommended. Some cases clear up without treatment after several months. Surgical removal of the scar tissue may be necessary.
E Testicular Disorders
Testicular disorders include varicosity of the veins surrounding the testicle (varicocoele); twisting (torsion) of the spermatic cord—a painful condition calling for urgent surgery if the testicle is to be preserved; a collection of fluid around the testicle (hydrocoele); and cancer of the testicle. In connection with the latter, it is now established that regular monthly self-examination of the testicles, in which the whole surface of each is carefully felt for hard lumps, can be life-saving. Testicular cancer, which is on the increase in developed countries, tends to affect younger men and can be cured if detected reasonably early.
Impotence is a major area of men’s health. It is the inability to achieve a penile erection of sufficient firmness to allow normal penetrative sexual intercourse. A small proportion of cases are actually caused by organic disorders such as diabetic nerve damage, hormonal changes, poor blood supply from local arterial disorders, multiple sclerosis, or spinal cord disorders. The great majority of cases are not of organic origin but have a psychological or social cause. Almost all men experience erectile failure from time to time and there are many causes. Much apparent erectile inadequacy is actually due to fear of failure, lack of desire, poor self-image, problems with a partner, or unsatisfactory “macho” attitudes to sex.
IV HEART ATTACKS
Arguably the most important aspect of men’s health is that concerned with the prevention of heart attacks. Coronary heart disease is the second most common cause of death in the United Kingdom for both men and women. Heart attacks are caused by the clotting of blood within a branch of one of the arteries that supply the heart muscle—the coronary arteries. Clotting of blood within a coronary artery, a coronary thrombosis, does not occur if the arteries are healthy. Atherosclerosis, the underlying arterial disease leading to thrombosis, features the deposition of cholesterol and other material in the lining of the arteries. From evidence gathered at thousands of postmortem examinations of men and women, men have been found to be far more prone to atherosclerosis than pre-menopausal women and should be aware of the risk factors for its development. These include smoking cigarettes, lack of exercise, obesity, a diet high in saturated (dairy) fats, and a family history of heart attacks and strokes at an early age. No clear evidence has been found to suggest that the normal stresses of a busy life increase the risk of heart attacks but high levels of stress may contribute, depending on the individual’s tolerance. Researchers are looking into the possibility that oestrogen may play a part in women’s greater longevity.
Robert M. Youngson