| SEXUAL DISEASES | IMPOTENCE | VASECTOMY | TESTICULAR PROBLEMS | PROSTATE CANCER |
IMPOTENCE
Impotence is a failure to sustain an erection sufficient for sexual intercourse.
The condition has both psychological causes and physical , although often both co-exist.
Physically the the causes may include:-
Drugs, Thiazides [diuretics ] , Beta blockers ,
Diabetes
Hypertension
Pelvic surgery including Prostate surgery
Neurological disorders
Ageing This is probably due to the smooth muscle of the penis becoming less effective
TREATMENTS
Psychosexual counselling is sometimes effective, although primarily it reduces the stress related to the condition.
Medical Treatments
Drugs have really totally replaced the use of implants and vacuum devices
1. Viagra . Sildenafil Works by increasing the nitric acid in the penis. It is supplied in doses of 25mg, 50 mg and 100mg and is generally effective in 50-80 % of cases. It duration is from 1-4 hours but will not achieve an erection by itself , merely by taking the table; unlike the penile injections. The main side effects relate to facial flushing , headaches and indigestion all of which are fairly minor. A few deaths have been related to viagra but these have virtually always related to patients already taking Nitrates , used for angina, which should never be used with it..
Viagra is really the first line medication for impotence however the prescibing guidelines have been somewhat convoluted. Initially it was only available on a private basis but since the government's guidelines this has been extended to a limited NHS availability.
Prescibing guidelines issued by North & East Devon Health Authority 1st February 1999.
The Government has extended the interim guidance on sildenafil, (HSC 1998/158) which was first issued in September1998. This means that the advice, to not prescribe sildenafil on the NHS, still pertains.
The Government has proposed that all treatments for erectile dysfunction should be prescribable once a week for men who:
· have had radical pelvic surgery or prostatectomy
· have spinal cord injury
· are diabetic
· have multip1e sclerosis
· have single gene neurological disease
For other men, who are caused severe distress due to impotence, it is proposed that treatment should be available only in exceptional circumstances as assessed by a hospital specialist.
Other treatments, for impotence, , that will be affected include.
· Caverject
· Erecnos
· Muse
· Viridal
· Preparations containing papeverine, thymoxamine, yobimbine and phentolamin
2 .Caverject .Alprostadil. This is a penile injection which is self administered but only after specialist instruction and is prescribable on the NHS. It is effective in over 50% of cases irrespective of the arousal of the patient.
3.. Muse Alprostadil This is the same medication as caverject although this can be inserted directly into the urethra avoiding injections. Both can be related to side-effects of which the most notable is priapism [ persistent erection ] which requires urgent treatment if lasting over 6 hrs, by attending a casualty department.
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Problems with the testicles are fortunately quite rare, but they can be serious. Testicular cancer is the biggest cause of cancer-related death in men who are 18 to 35 years. But if it's discovered early it is completely curable, so it's important to know how to detect the signs.
Signs and symptoms
· A lump on one testicle.
· Pain. tenderness or hardness in either testicle.
· Unusual discharge from the penis.
· Blood in the sperm at ejaculation.
Causes and complications
There is no single cause of testicular cancer, but your chance of getting it is increased if you have an undescended (absent) testicle, or if it runs in your family.
Checking your testicles
Cradle the scrotum in the palm of your hand and using both hands, gently roll each testicle in turn between your thumb and forefinger. Feel carefully for any lumps or swellings. The testicles should both be smooth except along the top and back, where you can feel the tube that carries the sperm. One testicle is often slightly larger than the other.
Prevention
Men should check their testicles once a month after a warm bath or shower.This makes the skin of the scrotum softer so it's easier to feel the testes.
Consult your doctor if:
· You feel anything out of the ordinary.
Remember, cancer is often painless, so don't delay.
· You develop pain in the testicle[ s ]
SUDDEN PAIN in the testis particularly in young boys needs URGENT assessment as the testis may have torted ( twisted ). Don't delay seeking help.
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The prostate is a small gland that sits just below the bladder and surrounds the urethra (the tube that carries urine from the bladder into the penis).
Good-quality research has shown that screening for breast cancer, for example, is an effective way of saving lives. However, little good-quality research has been carried out on prostate cancer screening. There are strong reasons to think that screening for prostate cancer will not have the same benefits as screening for breast cancer
As men get older, the prostate can get bigger and may cause problems with passing urine. In most cases, the prostate getting larger is not caused by cancer. Men who have prostate cancer might or might not have symptoms.
You should see your doctor if you have any worries or symptoms such as:
1.Difficulty passing urine
2. Getting up regularly at night to pass urine.
3. Blood in your urine.
Prostate cancer mostly affects men over 65. It is normally a slow-growing cancer. Most men over 65 with the disease will die of something else, usually without even knowing they have prostate cancer. Only a few of the men who have prostate cancer have a cancer which may kill them. However, prostate cancer is the third commonest cause of cancer death among men in the UK, after lung cancer and large-bowel cancer.
Is screening for prostate cancer useful?
One way which may reduce the number of deaths from some cancers is to find the disease at an early stage before and' symptoms have appeared. (This is sometimes called screening.) Treatment may be more likely to be successful if it is started early.
How useful screening is depends on several things, including:
1. the accuracy of the test;
2. how good the test is at finding out who does and who doesn't have the disease; and
3 whether effective treatments are available.
This explains what is known and what is not about a screening test for prostate cancer and about how effective current treatments are.
The PSA test
Screening test for prostate cancer involves a blood test for a substance called prostate specific antigen (PSA). Like most screening tests, it only gives an idea of whether the disease is present. If your PSA test result is high, you will normally need further investigations to reach a definite diagnosis.
PSA is made by the prostate gland. Men with prostate cancer often have higher levels of PSA in their blood than normal. However:
1. Some men who have prostate cancer do not have higher levels of PSA;
2. Some men who do not have prostate cancer do have higher levels of PSA; and
3. Two thirds of men who have higher levels of PSA do not have prostate cancer.
This means that the PSA test is not totally accurate in seeing whether there is cancer. PSA levels in the blood can be raised by several other conditions that affect the prostate gland. At the moment, the PSA test cannot tell the difference between men who have slow-growing prostate cancer and those who have the more aggressive disease.
If you have a PSA test, you will have to make several decisions. You need to think about what might happen when you get the test results.
What if the test result is normal?
If the test is normal, you probably do not have prostate cancer. Some men feel reassured by a normal result. However, the PSA test is not totally accurate. Up to 1% of men under the age of 50 will go on to develop 'invasive prostate cancer' (prostate cancer that spreads) in the next ten years. Among older age groups, slightly more men will go on to develop the disease.
What if the test result is high?
An unusually high level of PSA in your blood does not necessarily mean you have prostate cancer. Of every three healthy men who have a high PSA level, only one will have prostate cancer.
If the PSA test result is high, you will probably be offered further investigations to find out whether or not you definitely do have prostate cancer. These tests might include another PSA test, ultrasound scans and needle biopsy.
Ultrasound scans involve the doctor putting a probe into your rectum (back passage) to find areas of cancer. This might feel embarrassing and uncomfortable or painful, but very rarely causes serious problems.
The doctor might also use ultrasound to help take a needle biopsy. A needle biopsy normally involves the doctor putting a needle up your rectum and into your prostate gland to take small samples of tissue. The samples are then examined under a microscope to see if they contain any cancer cells. If they do, a doctor can estimate the grade and type of cancer by looking at the cells. He or she can then estimate how likely the cancer is to grow quickly. However, he or she cannot give any firm guarantees about the likely outcome.
The needle biopsy may be embarrassing and painful, and it has some risks. On average, of every 100 men who have a needle biopsy, between one and five will develop a complication. The main complications are infection and, more rarely, bleeding which lasts a long time.
If the ultrasound or biopsy tests confirm you have prostate cancer, you and your doctor then face decisions about what to do about it.
Treatment options for prostate cancer
There are three options for people with prostate cancer that has not spread to other parts of the body:
1. An operation to remove the prostate;
2. Radiation therapy; or
3. Watchful waiting.
There is no clear research evidence to tell us whether any of these treatment options do more good than harm. The studies which have been done do not suggest that any one option is better than the others.
Surgery (an operation to remove the prostate)
A surgeon will carry out an operation called a 'radical prostatectomy' to remove the prostate gland and the cancer cells it contains.
However, there is no clear research evidence to tell us whether men with prostate cancer who have their prostate removed live longer than those who do not.
For every 1,000 men with prostate cancer treated with surgery:
1. Between three and 20 will die because of the treatment;
2. Between 200 and 850 will experience impotence (when you can't get an erection); and
3. Between 10 and 270 will develop urinary incontinence.
It is difficult to predict who may benefit from surgery and who is likely to experience complications
Radiation therapy
A beam of X-rays can be directed to the prostate gland to destroy cancer cells.
Again, there is no clear research evidence to suggest that this treatment makes men with prostate cancer live longer.
For every 1,000 men with prostate cancer treated with radiation therapy:
1. Between two and five will die as a result of the treatment;
2. Between 400 and 670 will experience impotence (when you can't get an erection); and
3. Between 10 and 30 will develop urinary incontinence.
Watchful waiting
Watchful waiting involves keeping the cancer under review. A series of PSA tests may be taken to see whether your PSA levels are rising. The cancer is only actively treated if it grows quickly or causes problems.
Watchful waiting has no immediate risks, but of course the cancer may grow and cause problems during the waiting period.
Prostate Help Association http://www.u-net.com/~pha/
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