As part of our ongoing series of educational breakfast meetings we were recently privileged to have hosted Professor Asif Muneer, Consultant Urological Surgeon and Andrologist at University College Hospital. He completed his Doctor of Medicine qualifications at UCL, investigating the physiology of male genital smooth muscle dysfunction. He presented a talk on Male Sexual Dysfunction, causes and treatments.

To watch the talk or download the slides please click on the links below.

If you would like to be kept up-to-date on future talks please visit events.medicalpracticemarylebone.co.uk and complete the form and you will be notified of upcoming events.

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The prostate gland is part of the male reproductive system.

The word ‘prostate ‘is taken from the Greek expression meaning ‘one who stands before’ – which describes the position of the prostate in-front of the bladder. The prostate surrounds the top of the urethra, the tube that drains urine from the bladder.’ The primary function of the prostate is to produce the seminal fluid that nourishes and transports sperm in the semen during ejaculation.

As men get older the prostate tends to grow in size and this enlargement is caused by one or more of the three following conditions:

BPH (Benign Prostatic Hyperplasia) – a normal condition of ageing where an enlarged prostate gland puts pressure on the bladder and urethra causing:

• Difficulty starting urination

• A frequent or urgent need to urinate (particularly at night)

• Inability to fully empty the bladder

Prostatitis – Inflammation, and/or swelling, of the prostate gland which can sometimes be extremely painful and distressing. 

Prostatitis can be severe and come on suddenly (acute), often caused by a bacterial infection and requires immediate treatment with antibiotics, this though is rare but can be potentially life-threatening.

More commonly Chronic Prostatitis is seen in General Practice where the patient complains that symptoms come and go over several months, including pain in the groin, pain when passing urine with a frequency or urgency to urinate, the cause is often unknown.

Prostate Cancer – The most common cancer in men in the UK and one of the easiest to treat if caught early. It is usually slow to develop so there may be no signs for many years until the prostate is large enough to affect the urethra causing an increased need to pass urine and a feeling that the bladder is not fully emptied.

Many of the initial symptoms of these three conditions, BPH, Prostatitis and Prostate Cancer overlap and therefore none of the symptoms, should ever be ignored; a medical check with the Doctor is always encouraged.

Many men are very cautious when seeking medical help with urinary problems often due to embarrassment but also fearing what the Doctor may find, and what tests or examinations may be performed, so it’s useful to understand what to expect when attending for an appointment to discuss urinary problems.

The Doctor will usually start with:

 • A full history, including any family history of Prostate cancer which may be very significant.

• Examination of the abdomen and rectum, the latter to ascertain if the prostate is enlarged

• A blood test known as the PSA – Prostate Specific Antigen Test, a sensitive, but not a very specific test, this means it will pick up any prostate issues, but the cause could be many things, BPH being the most common – many patients become concerned and anxious when the PSA is high but reassuringly it does not often indicate Cancer.

MRI Scan

If the PSA test does come back raised an MRI scan of the prostate may be offered to help decide if any further testing and treatment is required.

Biopsy

If suspicious areas are visualised on the MRI scan then a biopsy of the area will be taken of these.

There are two main types of biopsy:

• Transperineal ultrasound guided method, where a needle goes through the skin between the testicles and the back passage (the perineum).

• Trans- rectal ultrasound guided biopsy (TRUS), where a needle goes through the wall of the back

passage.

Prostate Cancer – Treatment

Prostate biopsy results will take at least 1 week, and treatment options will be discussed when they are received. Consideration is given to age, general health, PSA level, Gleason grade and stage of the tumour. Surgery, hormone treatment, chemotherapy and radiotherapy are all options that will be discussed, and the appropriate pathway chosen in conjunction with the patient and the stage of the cancer.

If the tumour is at low risk of progression, it may be more appropriate for the cancer to be monitored closely and treated only if there are signs of progression.

BPH

Treatment for BPH depends on the severity of symptoms and the effect on quality of life.

Simple treatments can include lifestyle changes, bladder training, medications that help to relax the muscle in the prostate gland, other options include simple surgery, and more invasive surgery if required.

Chronic Prostatitis

Treatment of Chronic Prostatitis is usually aimed at symptom control.

Depending on how long the symptoms have been present the following may be suggested:

• Painkillers, such as paracetamol or Ibuprofen

• A medication known as an Alpha-blocker to help to relax the muscles in the prostate gland and the base of the bladder, which improves urine flow

• Antibiotics

• A laxative, if passing stools is painful, (due to the close proximity of the rectum to the prostate)

The most important message to be taken from this is that prostate problems are common, particularly in men over 50 years, and early consultation with your Doctor is to be encouraged. If you are experiencing any of the symptoms mentioned and listed again here:

• The need to pass urine more frequently, particularly at night,

• The need to rush to the toilet

• Difficult starting to urinate

• Straining or taking a long time to pass urine

• Weak flow

• Feeling that your bladder has not emptied fully

• Blood in your urine or semen

#medicalpracticemarylebone #prostate #prostatecancer #cancer #menshealth #urology #prostatehealth #prostatitis #men #oncology #prostatecancerawareness #cancerawareness #erectiledysfunction #bph #trus #urologist #psa #privateclinic #privatedoctor #privategp #privategplondon #privatehealthcare #gpharleystreet #menshealth #harleystreet

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Erectile dysfunction (ED) is a common problem where a man finds it difficult to get or keep an erection. Also known as impotence. Unfortunately, even though it is often seen as a taboo subject, most men will experience ED at some point in their life. ED can cause relationship problems, embarrassment and low self-esteem, stress and anxiety, and fertility issues for a couple.

Causes of ED are complex. In order to obtain an erection, a man needs to have healthy blood vessels, nerves, male hormones and a desire to have sex.

There are many physical as well psychological causes for ED.

The medical causes can include:

• Diabetes Mellitus
• Heart disease
• High blood pressure
• High Cholesterol
• Parkinson’s disease
• Multiple Sclerosis
• Sleep disorders
• Treatment for prostate cancer or in large prostate
• Surgeries or injuries that affect the pelvis or spinal-cord
• Certain prescription medications
• Low testosterone.

Case study, a patient in his 20s, newly diagnosed diabetic who is suffering with ED in silence. This has been bothering him and he has no idea that this could be related to his diabetes. He is treated with Viagra. Once he understands the cause, he is able to overcome his psychological fears which are making the problem worse. It causes low self-esteem and paranoia about sexual failure. He is much more relaxed and it is no longer a problem.

The lifestyle causes:

• Alcoholism
• Substance abuse
• Smoking
• Obesity

The brain plays a key role in triggering a number of physical events which cause an erection.

Psychological causes play a key role:

• Depression, anxiety and other mental health conditions
• Stress
• Relationship Problems
• Low self-esteem and paranoia about sexual failure

These are estimated to cause between 10% and 20% of ED cases alone.

To diagnose ED there will need to be:

• A full medical history taken including a medical and sexual past history, any prescription or non-prescription drug use
• Physical examination, as bodily features can give clues to the cause
• Laboratory tests can also be key for diagnosing ED
• Further tests such as monitoring nocturnal erection (nocturnal penile tumescence) can help to rule out some causes
• Psychological examination can reveal any psychological factors

Poorly controlled diabetes can lead to damage of nerves and blood vessels caused by poor long term blood sugar control. Erectile dysfunction can also be the first sign of coronary artery disease where plaque builds up in the arteries.

Try to cut down on the cigarette smoking, limit alcohol and stop any illicit drug use.

Regular exercise, a balanced healthy diet, adequate sleep and stress management will all help.

Treating ED

Medications:

There are a number of oral medications that can be prescribed to help improve blood flow to the penis. These include well-known brand names such as:

• Viagra

• Cialis

• Levitra

These medications can affect the heart and interact with other medications. Please consult your doctor before taking.

Alternative treatments include:

Vacuum constriction devices. A pump creates a vacuum that will draw blood into the penis making it erect. A rubber ring will need to placed around the bottom of the penis to keep it erect.

Alprostadil is a form of hormone medication that stimulates blood flow to penis and may be given by two different methods: Intracavernous injection therapy where alprostadil is given by injection into the penis. Intraurethral application where a pellet of alprostadil is inserted into the urethra via a urethral stick.

Psychosexual Therapy

Any underlying psychological factors can be addressed.

Cognitive Behavioural Therapy (CBT) is often used in addressing ED as it is a proactive and actionable therapy targeted at helping you change the way you think and behave. It can be used to address any performance anxiety, low self-esteem, and loss of sexual arousal.

Erectile Dysfunction Moving Forward

There are frequent advances in this field. Better medications, implants, vacuum devices and suppositories have all increased options for men suffering with ED.

Men are renowned for not wanting to talk about feelings, weaknesses or struggles. Erectile dysfunction is a medical condition like any other and needs to be discussed openly. No taboos, no stigma; let’s talk. 

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