Under the covers with men’s sexual health issues
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?
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 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.