Under the covers with men’s sexual health issues

2016-06-02

New treatments on offer for many problems men may perceive as being embarrassing or distressing

Do a quick Google search for women’s health. You’ll receive approximately 152 million results. Do the same for men’s health and you will get 22.3 million. Is this sexism in another guise, or is it purely indicative of male reluctance to discuss their health issues, even with Dr Google?

Under the covers with men’s sexual health issues

Consultant urologist and andrologist at University Hospital Waterford (UHW)Ivor Cullen says men should be aware that there is a wide range of solutions to many problems they may perceive as being embarrassing or distressing.

Cullen trained in several ground-breaking techniques during his time working in the leading urology centre at University College London Hospital. Many of these have not been available in Ireland until now.

Breakthroughs in fertility medicine have not just been confined to female fertility issues; the area of male infertility has seen a revolution in recent times, says Cullen.

Sexual dysfunction has also moved on from the “little blue pill”. When Viagra doesn’t work, there are many other options for men struggling with erectile dysfunction.

The important thing to remember is that no worrying or “embarrassing” health problem can be addressed if a man doesn’t approach his GP or health professional about it, Cullen says.

Erectile dysfunction

Erectile dysfunction affects about half of all men at some point in their lives. For some it may just be temporary, but for others it can be a persistent problem. For some this can be treated with physiotherapy and muscle re-education exercises. It can also be treated with medications – the phosphodiesterase type 5 inhibitors (such as Viagra).

However, for those men who do not respond to these treatments, there is now the surgical option of an inflatable penile prosthesis.

As part of this procedure, hydraulic pumps are inserted so that men with erectile dysfunction can have functioning erections and have sex normally.

Although this procedure has been offered in Ireland before, in Cullen’s opinion, the uptake has been quite poor, mainly owing to a lack of knowledge in the area among both patients and the health profession at large.

“Penis implant surgery is just not requested or desired by patients as they are unaware of the option,” says Cullen, contrasting this with his experience in London where a significant proportion of men with ED are aware of and will choose the implant surgery as an option when the medications fail.

“It has been offered to a limited number of patients in one or two centres. There is very little knowledge about penis implant surgery. No one talks about it here, but in other parts of the world that’s not the case, it’s quite commonplace.”

According to Cullen, common candidates for this procedure are younger men with type 1 diabetes who often ultimately get erectile dysfunction early in life, often starting after the age of 40 and medication eventually does not work.

In addition, men who have had their prostates removed or had radiation or hormonal treatment, usually as a result of prostate cancer, would also benefit from this surgery, as the majority of these will lose the ability to have an erection and often will not respond to the usual medications.

The procedure can be carried out by Cullen and his team at UHW. A three-piece hydraulic inflatable implant is inserted, which isn’t visible externally. A small pump sits in the scrotum, much like a third testicle, explains Cullen. The two-piece prosthesis is implanted in the penis, while a reservoir is laced in the lower abdomen. When the pump is squeezed, the fluid goes from the reservoir into the prosthesis and makes it erect.

This ensures a rigid erection every time, satisfactory for penetrative intercourse and dispensing with the need for expensive medications or injections.

“Obviously that’s not for everyone but it is a fantastic addition to our options. Satisfaction rates with penile implant surgery are always remarkably high – 90-95 per cent. In a well-chosen patient who is properly counselled, it can be a wonderful option for erectile dysfunction,” Cullen says.

Kandasana the Best Yoga Position for Improved Sexual Functioning

2016-05-25

Some men today prefer to take part in natural, alternative therapies for their healthcare needs. This is also true when it comes to erectile dysfunction.Many men are embarrassed or afraid to address the condition with their doctor. Others do not want to take medication if there is a natural alternative, though ED drugs are safe, with very few side effects. Then there are those who are very interested in yoga, acupuncture, reiki, and other alternative practices, and believe in their therapeutic benefits. Yoga expert Abhishek Sharma suggests kandasana for ED. This is a particular yoga position or asana, recommended for millennia to conquer what was traditionally called impotence. According to Sharma it is also effective against premature ejaculation. The idea comes from traditional Ayurvedic medicine. Here the chakras—a line of nexus points starting at the crown and ending at the groin, control the flow of an unseen energy force. This yoga position is said to open up the chakra of the navel, and release sexual energy. In a medical sense, it may open up and stimulate the blood vessels of the groin and pelvic region, leading to better circulation. A lack of blood flow is one of the biggest causes of ED.

Understand that this position is not recommended for those with a bad back or knee injury. To perform it you first sit with your legs out in front of you. Stretch your legs sideways and then fold them at the knee. Pull in your legs toward you. Inhale slowly and place your feet against your navel using your hands. You need to practice balance at this time. Keep your back straight. Hold this position for a few breaths. Slowly lower your legs to the floor during exhalation. You can rest for thirty seconds and then repeat the pose. Make sure to learn it from an instructor in order to perform it correctly. It is important to realize that no scientific studies back the use of yoga to undo ED. Many physicians do say that sexual functioning can improve greatly through exercise and an overall healthy lifestyle. Still, any man experiencing ED should talk with his doctor or an urologist as a more pressing, potentially life-threatening condition may be the cause.

Your First Gynecologist Exam

2016-05-09

If you’ve never been to a gynecologist, you may be nervous about what happens during an ob-gyn exam. Put yourself at ease and use it as an opportunity to learn more about your body and your health.

By Madeline Vann, MPH | Medically reviewed by Lindsey Marcellin, MD, MPH

A gynecologist is a doctor who specializes in women’s reproductive health issues. When you first try to find a gynecologist, you may see that some are called obstetrician-gynecologists or ob-gyns. This refers to the training they have undergone to treat women from adolescence through pregnancy and delivery.

If you haven’t been to an ob-gyn before, you may wonder why you should find a gynecologist and what to expect when you get there.

Reasons why you should have a gynecologist exam include:

• To learn about birth control options
• To learn about screening for and preventing sexually transmitted diseases
• For an annual pelvic exam
• Screening for reproductive cancers, such as a Pap smear, starting at age 21 and then every two years (some women may need to have it more frequently, based on their doctor’s recommendations, while others may only need it every three years)
• To find out about human papillomavirus (HPV) vaccination
• For care for yourself and your baby during pregnancy

When to See a Gynecologist

Guidelines about when to have a gynecologist exam include:

• When you are 21 or earlier if you become sexually active
• If you have unusual bleeding or irregular periods
• If you stop having periods for three months or more
• If you suspect or know you are pregnant
• If you have been trying to get pregnant without success
• If you have pelvic pain
• When you are between 40 and 50 to get your first mammogram referral
• After menopause for bone density screening referrals

How to Prepare for a Gynecological Visit

Take these steps to make sure you get the most out of your gynecologist exam:

• Do not douche, have vaginal intercourse, or use a vaginal cream or suppository for 24 to 48 hours before your visit.
• Write down anything that has been worrying you, such as irregular periods or unusual discharge or discomfort — and bring pen and paper to write down the answers.
• Bring a list of all medications, vitamins, and herbal supplements that you are taking.
• Be able to share your family health history, especially reproductive health problems in family members.

What to Expect at Your First Gynecologist Exam

Here is what you can expect at your ob-gyn appointment:

• Health history. A nurse will ask you questions about your personal health history and your family health history. She may also ask about health behaviors such as drinking alcohol, smoking, using illegal drugs, and sexual history. Some of the questions may feel very personal to you, but remember that everything that you share is private between you and your doctor unless you give written permission for it to be discussed with someone else.
• Vital signs. The nurse will weigh you and check your blood pressure.
• Pre-exam. You will be given a gown that opens in the front to wear and a sheet to cover your legs. You will need to remove all clothes including undergarments.
• Discussion. Your ob-gyn will talk to you briefly about your concerns and will explain the gynecologist exam to you. This is a good time to bring up any questions you have.
• Breast exam. Your ob-gyn will use her fingers to feel each breast and nipple in a pattern. This is to find unusual lumps or changes in tissue and skin.
• Pelvic exam. You will lie on the exam table with your knees bent and your feet resting in stirrups to keep your legs apart. Your ob-gyn will sit at the end of the table for the exam. “A pelvic exam includes inspection of the vulva, insertion of a speculum to allow inspection of the vagina and cervix, the bimanual exam with two fingers in the vagina and another hand on top of the abdomen to examine the uterus, fallopian tubes, and ovaries,” explains ob-gyn Concepcion Diaz-Arrastia, MD, director of gynecological oncology and associate professor at Baylor College of Medicine. The speculum is an instrument that slides smoothly into your vagina to stretch it slightly so your doctor can take samples from your cervix. The pelvic exam should not be painful, but there may be some discomfort or pressure, and the speculum may feel cold at first.
• Pap smear. During the pelvic exam, your doctor may take cells from your cervix for a Pap smear, which tests for precancerous changes of cervical cells. This is not painful.
• STD testing. If you request it or your doctor recommends it, she can also take samples from your vagina to be tested for sexually transmitted diseases (STDs). Some STDs have to be found using a blood test.
• Discussion. Your doctor will let you know if she sees anything unusual and may recommend additional testing based on this exam, such as a mammogram, bone density test, or blood work. This is another opportunity for you to ask more questions, including any about her findings or suggestions. The results of the Pap smear and STD tests will not be available for a week or more, but at this point your doctor can give you a prescription for birth control or any medication that you need.

You may be nervous about having your first gynecologist exam, but think of your ob-gyn is your partner in sexual health. She should become the practitioner you feel most comfortable talking with about some of your most private health issues.

Learn more in the Everyday Health Sexual Health Center.

Trichomoniasis: Symptoms, Treatment and Causes

2016-05-06

Sex After Pregnancy: When Can I Resume Intercourse?

Most mothers will agree that the last thing on their mind after having a baby is sex. However, this is not often the case with their partner! On the other hand, some women may be ready to resume sexual intercourse shortly after having a baby. But when is the right time to resume sexual intercourse?

In general, it is recommended that sexual intercourse is avoided for the first 4-6 weeks following a vaginal or cesarean (C-section) delivery; however, it is important to speak with your health care provider before resuming sex.

Most often, especially in cases of a C-section, perineal tear or episiotomy, it is recommended to wait until after you are seen for your 6-week postpartum visit for the green light from a health care provider to resume sexual activity.

Following childbirth, your body is in a healing phase in which bleeding stops, tears heal and the cervix closes. Having intercourse too early, especially within the first two weeks, is not recommended due to a risk of postpartum hemorrhage or uterine infection.

When a woman is ready to resume sexual intercourse following the birth of a baby depends on several factors, including:

Pain levels
Fatigue
Stress
Sex drive
Fear of sex or pregnancy
Vaginal dryness
Postpartum depression.
What will sex after giving birth feel like?
Due to the hormonal changes experienced during the postpartum period, many women experience vaginal dryness, which may continue past the typical 4-6 week timeframe if breastfeeding; this is due to low levels of circulating estrogen.

Breastfeeding can also lower your sex drive. In addition to lower levels of circulating hormones, painful sex may accompany a perineal tear or episiotomy, which can last for several months following the birth of a baby.

Steps that can reduce pain associated with sex after pregnancy include:

Controlling the depth of penetration with varied sexual positions
Increasing vaginal lubrication
Taking pain medication
Emptying the bladder
Taking a warm bath.
Vaginal lubrication such as over-the-counter creams or gels may be useful in relieving the symptoms of vaginal dryness. If you are using barrier method birth control, using a water-based lubricant is recommended to avoid weakening the latex.

Alternatively, oral or manual stimulation may be an option during the healing process. For some people, an appointment with a pelvic floor rehabilitation specialist may be recommended to evaluate and treat painful postpartum sex.

Sex following childbirth may feel different due to decreased vaginal muscle tone and stretching. Typically, this laxity in vaginal tone is temporary, however, and is affected by factors such as genetics, the size of the baby, the number of previous births and the use of Kegel exercises.

Instructions on how to do Kegel exercises can be accessed here.

Hormones can cause a variety of interesting – and, at times, inconvenient – symptoms. For example, during sexual intercourse, your breasts may leak milk due to the hormonal response to orgasm. Try pumping before having sex to reduce this symptom.

One Technique to Avoid When Trying to Appear Larger

2016-05-03

Lots of guys worry about their size. Even though study after study has shown that the vast majority are in the average range, this preoccupation has not dissipated. If anything, the advent of the internet, specifically internet pornography, but dating sites and social media too, has made this obsession worse. Enhancement ads litter the internet, from bizarre and mostly likely dangerous devices, to pills with ineffective and even toxic ingredients. Yet, legions of males purchase these every day, whether risky or not. Then there are subtle techniques men use to give themselves a boost, visually. They display it to their lover from the side, instead of a top-down or frontal view. In this way, it will appear bigger. Some men work extra hard to get rid of belly fat in order to make themselves look well endowed. Then there are certain positions that give one greater depth and so the feeling of filling her up. But one technique often touted, that you should avoid doing, is shaving off all your pubic hair.

Lots of men’s magazines and other resources recommend this. The lack of thick tuffs of hair will of course make it appear larger. But there is a downside. First, there is a nickname for this phenomenon, a “freshly plucked turkey.” Few men want their genitalia to be referred to in this manner. Guys are very penis centered its true. Yet, they aren’t trying to impress themselves or even rivals, but women. It is how women evaluate such things that men should be concerned about. A recent study found that women generally remembered a penis being larger after intercourse than it actually was. Generally speaking women are less than thrilled with the visual a penis gives anyway. The male anatomy is not considered aesthetically pleasing.

Instead, it is the emotional bond she has with her partner that a woman focuses on. Now the downside, surprising her with a shaved pubic area could give her a shock. She might wonder what made you do it, and why this obsession with size. Being taken aback may even kill the mood. Really, just be confident and she will respond to the tone you set and your performance, not your equipment. Now for those concerned about performance, especially those suffering from PE or ED, talk to your doctor or an urologist. There are many therapies available today to overcome these common problems. What’s more, a concerning health issue may be at its root.