Transcript Men`s health topics

MEN’S HEALTH
Systems III
Dr. Alex Alexander
WTR 2013
MALE REPRODUCTIVE
ANATOMY
• Immature sperm are formed in the testes (formation
depends on cooler temps)
• Sperm mature as they pass thru 20 ft long epididymis (a
20 day cruise), a coiled tube that sits on top of each
testicle
• Sperm then travel thru the vas deferens to the seminal
vesicle where they are stored and mix with mucous that
is made here.
• Upon demand, sperm pass thru the ejaculatory duct into
the prostate gland where it meets up with the urethra.
Cowper’s gland contributes more mucous for easy
passage thru the urethra
• Sperm then travel in what is now called semen out the
urethra. Urine cannot pass when semen is exiting.
MALE SEXUAL DEVELOPMENT
• At age 10-14, boys begin puberty, which lasts until 15-17
years old
• The signs that the testes are maturing are the production
of testosterone (secondary sexual characteristics) and
sperm (ejaculation).
• First ejaculation often involuntary and at nighttime (“wet
dream”) which is normal.
• LHRH (leutinizing hormone releasing hormone)
produced by the hypothalamus and tells the pituitary to
secrete LH and FSH.
• LH triggers the production of testosterone
• FSH triggers the production and development of sperm
TESTOSTERONE
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Male sex drive
Growth of penis, testes, and scrotum
Growth of larynx and deepening of voice
Rugae in scrotal skin
Growth of seminal vesicles and secretion of fluids rich in
fructose
Growth of prostate gland
Secretion of prostatic fluid
Stimulation of sperm production
Maintenance of erectile function
Fusion of bone growth plates
Maintenance of muscle bulk
DIHYDRO-TESTOSTERONE
VIA 5-ALPHA REDUCTASE IN PROSTATE AND HAIR FOLLICLES
• Growth of hair on face, in armpits, and on
extremities
• Male pattern pubic hair growth
• Male pattern baldness
• Acne
• Benign enlargement of the prostate gland
WHAT IS CIRCUMCISION?
• Surgical removal of all or part of the foreskin of the penis
• Advocates for circumcision that it provides important health
advantages which outweigh the risks, has no substantial effects on
sexual function, has a low complication rate when carried out by an
experienced physician, and is best performed during the neonatal
period
• Opponents of circumcision argue, for example, that it is a practice
which has historically been, and continues to be, defended through
the use of various myths; that it interferes with normal sexual
function; is extremely painful; and when performed on infants and
children violates the individual's human rights.
• The AMA stated in 1999: "Virtually all current policy statements from
specialty societies and medical organizations do not recommend
routine neonatal circumcision, and support the provision of accurate
and unbiased information to parents to inform their choice."
ERECTILE FUNCTION
ERECTILE DYSFUNCTION
• The inability to achieve or maintain an erection sufficient
for sexual intercourse at least 25% of the time.
• Can indicate an underlying medical problem; no longer
thought of as “normal with aging”.
• Under-diagnosed due to the embarrassment factor, but
being talked about more since the marketing of Viagra
• Often is psychological, although there are many physical
reasons for it too. Often multi-factorial.
• If men awaken with an erection or are able to
achieve/maintain erection during masturbation, suggests
psychological causes
CAUSES OF ED
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Athersclerosis
Heart, lung, kidney, liver disease
High blood pressure
Diabetes
Obesity
Medications (antidepressants, antihistamines, high blood pressure
meds, pain meds)
Tobacco, alcohol, drug use
Neuro problems: Parkinson’s, MS, spinal cord or nerve injury, stroke
Low testosterone levels
Treatments for prostate issues
Depression, anxiety, stress, fatigue
Communication problems or conflict with partner
Cycling
TREATMENT FOR ED
• Address underlying cause as best as possible
• Phosphodiesterase inhibitors (Viagra, Cialis,
Levitra)
– Should NOT take if you are on some other meds
(nitrates, coumadin), if blood pressure is very low or
uncontrolled high, out of control diabetes, heart
disease, or if you’ve had a stroke
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Prostaglandin E
Testosterone replacement if low
Penis pumps and implants
Counseling, sex therapy
THE PROSTATE GLAND
• The main function of the prostate is to
store and secrete a clear, slightly alkaline
(pH 7.29) fluid that constitutes 10-30% of
the volume of the seminal fluid that, along
with sperm, constitutes semen. The rest of
the seminal fluid is produced by the two
seminal vesicles. The alkalinity of seminal
fluid helps neutralize the acidity of the
vaginal tract, prolonging the lifespan of
sperm
THE PROSTATE GLAND
• A healthy human prostate is slightly larger
than a walnut. It surrounds the urethra just
below the urinary bladder and can be felt
during a rectal exam
BENIGN PROSTATIC
HYPERPLASIA
• Enlargement of the prostate gland that occurs
naturally with age (50% by age 50, 75% by age
80)
• Symptoms can include frequency of urination
(may be noticed more at nighttime), trouble
starting to urinate, decreased stream, or urinary
retention (can’t urinate!)
• Can be confused as cancer because of the
enlargement and an increased blood
concentration of PSA (prostate-specific antigen)
BPH TREATMENT
• As long as it is benign and not an infection, it doesn’t
require treatment unless the symptoms are bad enough
• Initially, cutting back on fluid consumption, esp at
bedtime, as well as caffeine and alcohol, can help
• Herbal: Saw palmetto, stinging nettles
• Medication options include
– 5-alpha reductase inhibitors (Proscar & Avodart): blocks
testosterone to prevent its enlarging effect  ED
– Alpha blockers (Flomax, Hytrin, Cardura): relax smooth muscles
of the prostate and bladder neck  HA, lightheadedness, fatigue
• Surgery
– Transurethral resection of the prostate (TURP)  may lead to
ED
– Laser surgery is less invasive but may not last as long as TURP
PROSTATITIS
• Acute or chronic inflammation of the prostate gland
• Usually caused by bacterial infection
• Acute: onset of dysuria, frequency, urgency, hematuria,
fever/chills, pain in low back or groin, painful ejaculation.
Caused by bacteria in the prostate which may be from
bladder or urethral infection (UTI or STD)
• Chronic: many of these symptoms (usu not fever) with a
gradual onset and symptoms come and go/wax and
wane. Unclear what causes. Maybe bacteria brought
from elsewhere in the body or an incompletely treated
acute episode.
• Treatment: antibiotics and anti-inflammatories
PROSTATE CANCER
• The Prostate Specific Antigen (PSA) Debate
• It is the most common non-skin cancer in America,
affecting 1 in 6 men. A non-smoking man is more likely
to develop prostate cancer than he is to develop colon,
bladder, melanoma, lymphoma and kidney cancers
combined. In fact, a man is 35% more likely to be
diagnosed with prostate cancer than a woman is to be
diagnosed with breast cancer.
• In 2008, more than 186,000 men will be diagnosed with
prostate cancer, and more than 28,000 men will die from
the disease. One new case occurs every 2.5 minutes
and a man dies from prostate cancer every 19 minutes.
• Risk factors: African American, family history, diet and
lifestyle factors
SX’S OF PROSTATE CANCER
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Nocturia and/or daytime frequency
Difficulty starting or holding back urine
Weak or interrupted flow of urine
Dysuria
Erectile difficulty
Painful ejaculation
Blood in urine or semen
PROSTATE CANCER
• Because approximately 90% of all prostate
cancers are detected in the local and regional
stages, the cure rate for prostate cancer is very
high—nearly 100% of men diagnosed at this
stage will be disease-free after five years.
• Generally a slow-growing cancer, and often men
die of other causes before the cancer affects
them.
• If it spreads, it tends to go to the bones.
PROSTATE CANCER
• Treatment for prostate cancer may involve watchful
waiting, surgery, radiation therapy including
brachytherapy and external beam radiation, High
Intensity Focused Ultrasound (HIFU), chemotherapy,
cryosurgery, hormonal therapy, or some combination.
Important factors are the man's age, his general health,
and his feelings about potential treatments and their
possible side effects. Because all treatments can have
significant side effects, such as erectile dysfunction and
urinary incontinence, treatment discussions often focus
on balancing the goals of therapy with the risks of
lifestyle alterations.
EPIDIDYMIS
• The place where sperm are stored, and when
called upon, mature into swimmers and are
carried into the vas deferens for transport.
• During ejaculation, sperm flow from the lower
portion of the epididymis (which functions as a
storage reservoir). They are packed so tightly
that they are unable to swim, but are transported
via the peristaltic action of muscle layers within
the vas deferens, and are mixed with the diluting
fluids of the seminal vesicles and other
accessory glands prior to ejaculation (forming
semen).
EPIDIDYMITIS
Epididymitis is inflammation of the epidydymis, usually
caused by infection. Usually an STD (chlamydia and
gonorrhea) but can be UTI critters.
Epididymitis usually has a gradual onset. On physical
examination, the testicle is usually found to be in its
normal vertical position, of equal size compared to its
counterpart, and not high-riding. Typical findings are
redness, warmth and swelling of the scrotum, with
tenderness behind the testicle, away from the middle
(this is the normal position of the epididymis relative
to the testicle)
Treatment is antibiotics for the infection. If left untreated,
can cause chronic epididymitis which can cause
infertility.
Epididymitis
VARICOCELE
• Varicocele is an abnormal enlargement of the veins in
the scrotum draining the testicles. The testicular blood
vessels originate in the abdomen and course down
through the inguinal canal as part of the spermatic cord
on their way to the testis. Up-ward flow of blood in the
veins is ensured by small one-way valves that prevent
backflow. Defective valves, or compression of the vein by
a nearby structure, can cause dilatation of the veins near
the testis, leading to the formation of a varicocele.
• There are most frequently diagnosed when a patient is
15-25 years of age, and rarely develop after the age of
40. They occur in 15-20% of all males, and in 40% of
infertile males.
VARICOCELE
• Symptoms of varicocele may include:
– Dragging and aching pain in the scrotum.
– Feeling of heaviness in the testicle(s)
– Infertility
– Atrophy (shrinking) of the testicle(s)
– Visible or palpable (able to be felt) enlarged
vein (bag of worms)
• Treatment is scrotal support, ligation of the
vein surgically, or venous embolization
Varicocele
VASECTOMY
• Tying off of the vas deferens for the purpose of
sterilization
• Ejaculate maintains 90% of volume
• Does NOT affect libido or erectile function (except
sometimes affects men psychologically)
• Can be done in a doctor’s office in 10-15 minutes! $350500, often subsidized by insurance. No needle/no
scalpel technique
• >99% efficacy in the first year, almost 100% after that
• Reversal procedures are $7000+ and work about 50% of
the time.
Vasectomy
MALE INFERTILITY
• The most common causes of male
infertility include abnormal sperm
production or function, impaired delivery of
sperm, general health and lifestyle issues,
and overexposure to certain environmental
elements.
Impaired Production or Function of
Sperm
• Impaired shape and/or movement
• Low sperm concentration (nl>20million/mL
of semen)
• Varicocele (heatlow sperm count/mobility)
• Undescended testicle
• Low testosterone
• Genetic defects
• Infections (STDsscarring, mumps)
Impaired delivery of sperm
• ED, premature ejaculation, low libido
• Retrograde ejaculation (semen enters bladder,
due to diabetes, medications, or h/o surgery)
• Blockage of vas deferens, epididymis, or
ejaculatory ducts
• Hypospadia (abnl location of urethral opening)
• Antisperm antibodies after vasectomy
• Cystic fibrosis (obstructed vas deferens)
General Health and Lifestyle
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Stress  low sperm counts
Malnutrition
Obesity
Cancer treatments
Alcohol and drug use
Age
Cycling  nerve damage
Environmental Factors
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Pesticide exposure
Overheating testicles
Drugs, esp cocaine and marijuana
Tobacco use
STDs
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Chlamydia
Gonorrhea
Herpes
HPV
INGUINAL HERNIA
• Protrusion of abdominal cavity contents through the
inguinal canal
• Direct or Indirect
• 7% of population will have one – common
• Occur more often in men due to the passage for the
descent of the testicles
• Hernias present as bulges in the groin area that can
become more prominent when coughing, straining, or
standing up. They are often painful, and the bulge
commonly disappears on lying down
• Complication is strangulation of intestines
• Recommended is surgical repair to prevent emergency
surgery sometime later
THE END