5: MEN’S HEALTH

Published on 27/05/2015 by admin

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Last modified 27/05/2015

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CHAPTER 5 MEN’S HEALTH

Erectile dysfunction

Premature ejaculation

Peyronie’s disease

Sexually transmitted infections

Scrotal swellings

Testicular pain

Testicular cancer

Abdominal aortic aneurysm screening

ERECTILE DYSFUNCTION

Estimated to affect approximately 1 in 10 men, erectile dysfunction is increasingly seen in general practice. It is defined as the inability to get or maintain an erection sufficient for the completion of sexual activity.

Management

• Lifestyle advice: advise the patient to try to avoid stress and anxiety, to reduce smoking and alcohol and to discuss any problems of sexual dissatisfaction with his partner.

• All treatments can be used for both psychogenic and organic causes.

• Phosphodiesterase type-5 inhibitors are usually effective irrespective of the cause, e.g. sildenafil, at a starting dose of 50 mg (25 mg in the elderly) approximately 1 hour before sexual activity. It should not be used in those receiving nitrates.

Most patients will need private prescriptions.

An NHS prescription can be issued to patients whose erectile dysfunction is felt to be caused by:

• pelvic surgery/trauma

• prostate cancer

• neurological disease

• severe emotional distress.

Remember to endorse these prescriptions ‘SLS’.

• Refer for psychosexual counselling, if appropriate.

• Consider referral to a urologist, e.g. for vasoactive injections, penile prostheses or vacuum devices.

PREMATURE EJACULATION

This is very common, particularly in young men having their first sexual relationships.

Assessment

History.

Ask whether the problem has been lifelong or of recent onset. Most men establish a pattern of ejaculating too soon for their liking, but recent anxiety, change of partner or of sexual position/practice may be the cause.

Ask if the man has discussed the problem with his partner. Many men are too embarrassed to do this but successful treatment is more likely if the partner is involved.

Examination.

This is not usually necessary, unless there is a complaint of penile/testicular pain or swelling.

Management

The general principle of treatment is to encourage the man to learn how it feels when he is about to ejaculate and to stop the stimulation before reaching that point, resuming when the feeling has declined. It can usually be treated satisfactorily by the stop/start or the squeeze technique: when the man feels close to ejaculation he should stop and relax for 30 seconds, or the woman should squeeze his glans for 30 seconds. Stimulation can then continue and the process may be repeated. The man will eventually improve his control.

Prescription of one of the SSRI antidepressants may help some men. Not only does the antidepressant effect help if there is associated performance anxiety, but the SSRIs, like most antidepressants, have the side-effect of delaying or preventing ejaculation in some men.

Referral for psychosexual counselling is often appropriate.

Related

Churchills Pocketbook of General Practice