Erectile dysfunction

Erectile dysfunction (ED), or impotence, is when a man has a problem attaining or maintaining an erection. The problem is common, with at least one in ten men in Britain having some sort of ED problem at some point in their lives and one in 20 men having a permanent ED problem. Men are often reluctant to discuss these problems, many of which can be overcome by relatively simple treatments. In around one third of men with ED, the cause is purely psychological and will often respond to non-clinical treatments, for example psychosexual counselling.

Unless there is a known problem, cases of ED should be investigated thoroughly. Cases of ED can be caused as a result of the side-effects of some drugs, particularly some anti-depressants. An erection relies on high blood pressure in the penis, so it is understandable that antihypertensives (drugs with blood pressure-lowering properties), such as ACE inhibitors, alpha and beta-blockers and calcium channel antagonists are known to cause problems with erections.

Alcohol can also have an erectile dysfunction-causing effect. Binge drinking has an immediate, short-term effect, but long-term alcohol abuse can lead to permanent ED problems. Smoking is also thought to cause ED.

Diseases that affect the nerves or blood supply can also cause ED, for example:

• multiple sclerosis
• diabetes
• problems with the circulatory system.

ED can be addressed by a number of methods:

• vacuum devices, which work by drawing blood into the penis under a gentle vacuum and are useful in men with vascular (blood vessel) problems
• herbal and traditional remedies, which are freely available, but for which there is little evidence for their effectiveness
• a range of drugs (for example Viagra™)
• injections into the penis, which although sound painful, are actually virtually painless because the needles used are so fine
• psychological treatment, such as psychosexual counselling (for problems with a psychological cause)
• avoiding alcohol.
  

Websites associated with erectile dysfunction

The NHS Direct on-line health encyclopaedia website contains a section on erectile dysfunction.
www.nhsdirect.nhs.uk/en

The Sexual Dysfunction Association is a charitable organisation, which was set up to help sufferers of erectile dysfunction and their partners, and to raise awareness of the condition amongst both the public and the medical profession.
www.sda.uk.net

Patient UK provides evidence-based information on health, disease and related issues, and is written by GPs. It contains lots of information on men’s health, including erectile dysfunction.
www.patient.co.uk

Action on Smoking and Health (ASH) has published an article, in conjunction with the British Medical Association, about how smoking can cause erectile dysfunction.
www.ash.org.uk

The National Library for Health contains many sections on erectile dysfunction.
www.library.nhs.uk

The European Men’s Health Forum (EMHF) is an independent, non-profit-making, non-governmental organisation that aims to raise the profile of men’s health at both a pan-European level and within individual countries. It encourages Europe-wide, national, local and regional organisations (both governmental and non-governmental) to include men’s issues in their health policies and practices. It also aims to improve delivery of health services to men and to influence men’s health-related behaviours. It has a factsheet on erectile dysfunction on its website.
www.emhf.org

Vasectomy

A vasectomy is a simple sterilisation operation performed in men. Commonly called ‘the snip’, the operation involves the vas deferens, the tube that transports the sperm from the testes to the penis, being cut and sealed. The process has to be carried out twice, as there are two vas deferens, one for each testicle.

Advantages of vasectomy:

• once it has been performed, there will be no interruption to sex, as for example with condoms
• after a man has been successfully sterilised through vasectomy, he will not need to worry about contraception again.

Disadvantages of vasectomy:

• it can take at least two months for a vasectomy to be successful (a semen sample should be checked for live sperm a few months after the procedure)
• although uncommon, the tubes can sometimes rejoin, restoring the person’s fertility
• sterilisation cannot be easily reversed, and a reversal operation may not be successful
• sterilisation does not protect a person from sexually transmitted infections.

The Royal College of Obstetricians and Gynaecologists (RCOG) produced guidelines in 2004 on male and female sterilisation.

NHS Quality Improvement Scotland (QIS) was set up as a special health board by the Scottish Parliament in 2003. Its role was to improve the quality of care and treatment delivered by NHS Scotland. As part of its role, NHS QIS investigated the sexual health services within Scotland and recommended how they can best support and improve the services offered around sexual health.

From their investigation, the group came up with five key clinical indicators (KCI) which would be used to monitor the improvement in sexual health care. Male and female sterilisation procedures are one of the KCI set out for 2006.

Click here for more detail on the NHS:QIS Sexual Health Services project preliminary report (June 2006).

Websites associated with vasectomy

The Family Planning clinic website has a section on male and female sterilisation.
www.fpa.org.uk

Marie Stopes International Global Partnership is an organisation that provides sexual and reproductive health information and services. It has a website covering options and services in the UK on abortion, contraception, emergency contraception, female sterilisation, health screening and vasectomies.
www.mariestopes.org.uk

NetDoctor is an on-line collaboration between doctors, healthcare professionals, information specialists and patients providing, wherever possible, quality-assessed information on the basis of the principles of evidence-based medicine. It has a section on male sterilisation.

The NHS Direct on-line health encyclopaedia contains a section on vasectomies.
www.nhsdirect.nhs.uk/en

Patient UK provides evidence-based information on health, disease and related issues, and is written by GPs. It contains lots of information on men’s health, including vasectomies.
www.patient.co.uk

The BBC Health web pages include a section on men’s health issues, and the site provides information about vasectomies in its ‘Ask the doctor’ section. www.bbc.co.uk

The British Pregnancy Advisory Service (BPAS), which is a non-profit making charity, provides a counselling service and NHS-approved abortion facilities. It operates nine clinics and has 32 branches in England, Wales and Scotland. It also has a section on vasectomies on its website.
www.bpas.org

Male menopause

It is commonly accepted that men, as well as women, can experience symptoms caused as a result of the reduction in the amount of the sex hormone, testosterone, that they produce. The male menopause is also known as the andropause. (The term ‘menopause’ literally means ‘menstruation stop’ and will usually be used to refer to the end of a woman’s periods, as a result of the reduction in the production of the female hormone oestrogen.)

Unlike women, many men experience few or no symptoms of the male menopause. This is because the fall in testosterone production is much more gradual than the fall in oestrogen production in women, occurring over decades rather than months or years as is the case in women. As such, it would better be described as ‘partial androgen deficiency of the ageing male’ or PADAM.

Production of testosterone starts to fall once a man is around the age of 40 or later. Other hormones, such as growth hormones also decrease in production. The symptoms of PADAM can include the following:

• circulation and nervous system effects:
• hot flushes
• sweating
• insomnia
• nervousness
• effects on mood and cognitive function
• irritability
• tiredness
• decreased sense of well-being
• lack of motivation
• low mental energy
• depression
• effects on masculinity, virility and sexuality
• decreased physical energy
• reduced muscle strength
• reduced libido (desire for sex)
• poor erections
• reduced quality of orgasms
• physical effects
• reduced muscle mass
• reduced body hair
• abdominal obesity (middle-age spread).

Many doctors do not believe that PADAM exists, and therefore will not offer any treatment. PADAM can be treated with testosterone, which can be in the form of capsules, injections, patches or implants. The long-term effects of testosterone in men with PADAM are unclear, and further research is needed, but a man suffering severe symptoms of PADAM may benefit from this treatment.

Websites associated with the male menopause

NetDoctor is an on-line collaboration between doctors, healthcare professionals, information specialists and patients providing, wherever possible, quality-assessed information on the basis of the principles of evidence-based medicine. It contains a section on the male menopause.
www.netdoctor.co.uk

The Andropause Society is a society for the study of androgen deficiency. It has several articles on its website on many aspects of the male menopause.
www.andropause.org

The BBC Men’s Health web pages contain a section on the male menopause.
www.bbc.co.uk

Prostate cancer

The prostate is a small, walnut-sized gland located just below the bladder. It is divided into three sections: the transition zone, the central zone and the peripheral zone. Prostate cancer can develop in any of these zones.



The function of the prostate gland is to make and secrete prostatic fluid. This is one of the five major fluids that make up semen and gives ejaculate its typical milky colour. Prostatic fluid comprises about a third of the entire ejaculate volume.

There are around 27,000 cases of prostate cancer newly diagnosed each year in the UK. It is the most common form of cancer in men, although it is rarely found in men under the age of 45 years. The risk of developing prostate cancer increases with age, and is relatively common in men over 80 years.

Cancer of the prostate is a serious disease but is often slow to develop. It is therefore important that it is detected early, when treatment is very successful.

Many men with early prostate cancer have no symptoms, but any enlargement of the prostate (cancerous or benign) can cause problems with passing urine. These problems include the following, although it is important to note that most men with these symptoms do not have prostate cancer:

• more frequent urination
• nocturia (waking frequently in the night to urinate)
• less warning prior to urination
• weak stream of urine that is difficult to start and stop
• dribbling of urine after urination.

Initial investigations include a blood test to measure levels of PSA (Prostate Specific Antigen), a protein only produced by the prostate, and a digital examination (that is with the fingers) of the gland itself through the rectum. Cancerous glands feel hard and irregular, whereas benign glands feel smooth and soft. If blood levels of PSA are raised, the prostate may be enlarged, infected or cancerous. Enlarged prostates (called benign prostatic hyperplasia, BPH) are common in men over the age of 50 years.

A high blood test or an abnormal-feeling prostate should be further examined by a urologist. The urologist should repeat the same investigations and, if the results still indicate an abnormality, should take a biopsy of the prostate to analyse for malignant cells. If the biopsy confirms prostate cancer, the patient should undergo further tests to check if the cancer has spread elsewhere in the body. The prostate should also be examined using a CT scan (computerised tomography scan) or an MRI scan (magnetic resonance imaging scan) in order to determine the best course of action.

Treatment for prostate cancer can include:

• watchful waiting, usually for small, slow-growing non-aggressive cancers in elderly men, for which the man is seen and checked regularly but no actual treatment is given
• prostatectomy, used in younger men who have small aggressive cancers that have not spread outside the prostate. The prostate is removed and the patient is followed up with regular PSA blood tests to check that the cancer has not recurred. Men are often unable to attain or maintain an erection after this procedure but the long-term outcome is good
• radiotherapy, in which X-rays are used to kill the cancer cells. This treatment is used for the same patient group as prostatectomy
• hormone therapy, in which testosterone levels are lowered using drugs causing the prostate cancer cells, which are very sensitive to testosterone, shrink. This treatment is most effective in men with cancer that has spread from the prostate to other areas of the body.

Websites associated with prostate cancer

The Department of Health has a report on the progress in prostate cancer treatment.
www.dh.gov.uk

The Prostate Cancer Charity was set up in 1996. Since then it has played a key role in raising both public awareness of the disease and political debate about services and support.
www.prostate-cancer.org.uk

The NHS Direct on-line health encyclopaedia contains a section on prostate cancer.
www.nhsdirect.nhs.uk

Cancer Research UK’s website has a section on prostate cancer.
www.cancerresearchuk.org

Cancer Help is a UK charity that offers news and information about prevention, diagnosis and treatment.
www.cancerhelp.org.uk

DirectGov contains a section on prostate cancer.
www.direct.gov.uk

The Nursing Standard website has a patient leaflet that contains a lot of information and advice on prostate cancer.
www.nursing-standard.co.uk

Prostate Research UK is a charity that supports research in all prostate diseases, including prostate cancer.
http://www.prostate-research.org.uk

NHS Direct has a Best Treatments website, in which there is a section on prostate cancer.
www.besttreatments.co.uk

NetDoctor is an on-line collaboration between doctors, healthcare professionals, information specialists and patients providing, wherever possible, quality-assessed information on the basis of the principles of evidence-based medicine. It contains a section on prostate cancer.
www.netdoctor.co.uk

Testicular cancer

Testicular cancer accounts for between 1% and 2% of all cancers in men, with around 2,000 new cases each year in the UK. It occurs more commonly in men aged between 15 and 35 years and is the biggest cause of cancer-related death in this group.

Any lump that a man finds in a testicle should be examined by a doctor.
Other symptoms associated with testicular cancer include:

• pain or a ‘dragging’ sensation in the testicles
• hardness in a part or all of the testicle
• accumulation of fluid within the scrotum
• presence of blood in ejaculated semen
• backache and abdominal pains as a result of the cancer spreading.

The main risk factor for testicular cancer is having had an undescended testicle, that is where the testicle failed to reach its proper position within the scrotum naturally. Testicular cancer is also seen more commonly in whites than in blacks, and in those from more affluent backgrounds.

Any abnormality in the testicles seen by a doctor should be referred to a specialist who will often carry out an ultrasound scan, which can usually distinguish malignant lumps from benign lumps. Blood tests to detect AFP (alpha fetoprotein) and BHCG (beta human chorionic gonadotrophin) can also help in the diagnosis and follow-up, as some cancers release these into the blood stream. The most informative test, however, is with an operation, in which the urologist will examine the testicle through an incision in the groin, or take a biopsy to be looked at under the microscope. If the testicle is found to be cancerous, it will be removed (orchidectomy). A prosthetic testicle can be inserted during the procedure.

Tissue from the removed testicle is examined by a pathologist to determine the type of cancer, as this affects the type of treatment used after surgery. There are two main types:

• seminomas (most common in 25 to 55 year old men), which is best treated with radiotherapy, or with chemotherapy if it has spread
• teratomas (more common in younger men), which do not respond to radiotherapy, but can be treated with chemotherapy.

Having only one testicle does not affect a man’s fertility or sexuality, however chemotherapy can reduce sperm counts permanently, causing fertility problems.

As testicular cancer is best treated early, all men should be advised to examine their testicles once a month. Information on self examination can be found on Netdoctor.

Websites associated with testicular cancer

Cancer Help is a UK charity offering news and information about prevention, diagnosis and treatment of cancers, including testicular cancer.
www.cancerhelp.org.uk

The NHS Direct on-line health encyclopaedia has a section on testicular cancer.
www.nhsdirect.uk/en

The Cancer Research UK website has a section on testicular cancer.
www.cancerresearchuk.org

CancerBACUP aims to give cancer patients and their families the up-to-date information, practical advice and support they need to reduce the fear and uncertainty of cancer. The website contains a section on testicular cancer.
www.cancerbacup.org.uk

NetDoctor is an on-line collaboration between doctors, healthcare professionals, information specialists and patients providing, wherever possible, quality-assessed information on the basis of the principles of evidence-based medicine. It contains a section on how men should check themselves for testicular cancer.
www.netdoctor.co.uk

Macmillan Cancer Relief website has a Why bother? section, in which there is information on testicular cancer.
www.macmillan.org.uk

Patient UK provides evidence-based information on health, disease and related issues, and is written by GPs. It contains lots of information on men’s health, including testicular cancer.
www.patient.co.uk

Smoking

Amongst other problems it causes, such as cancer and heart disease, smoking increases the risk of erectile dysfunction by around 50% for men in their 30s and 40s. It also can cause:

• a reduction in the ejaculate volume
• a reduced sperm count
• abnormal sperm shape
• reduced sperm motility.
  

Websites associated with men’s health and smoking

Action on Smoking and Health (ASH) has an article on its website, written with the British Medical Association about how smoking can cause erectile dysfunction.
www.ash.org.uk

The British Medical Journal has about 250 published papers on smoking.
www.bmj.com

The BMJ Publishing Group has published many different articles on smoking in its journals.
www.bmj.com

The American Journal of Public Health publishes peer-reviewed papers on original work in research, research methods, and programme evaluation in the field of public health. It also regularly publishes authoritative editorials and commentaries and serves as a forum for the analysis of health policy.
www.ajph.org

The European Network for Smoking Prevention (ENSP), an international non-profit making organisation, created in 1997 under Belgium law. Its mission is to develop a strategy for co-ordinated action among organisations active in tobacco control in Europe and to promote comprehensive tobacco control policies at both the national and European level. It has lots of information on smoking and the effects on men’s health.
www.ensp.org