Sexual Health and Wellness

IMAGE 1: MALE REPRODUCTIVE TRACT

IMAGE 2: MALE REPRODUCTIVE TRACT

TABLE 1: Parts of Male Reproductive Tract

Length

A non-erect penis usually measures between 8.5cm and 10.5cm (3-4 inches) from tip to base.

The average length is about 9.5cm (3.75 inches). Many factors can cause a temporary shrinkage of two inches or more, for instance cold weather or going swimming, so you needn't worry if you happen to fall short of the average figure.

Interestingly, most penises are very much the same size when erect. A guy whose non-erect penis is smallish will usually achieve about a 100 % increase in length during sexual excitement. A guy whose non-erect penis is already quite large will probably manage about a 75 % increase. This means the great majority of penises measure between 15cm and 18cm (6-7 inches) when erect, with the average figure being about 16.5cm (6.5 inches).

Width

The average width of a flaccid penis is 3.1cm (1.25 inches) and 4cm (1.6 inches) when erect.

Various Shapes

IMAGE 3: Various shapes ;-)

Uncircumcised or Circumcised 

IMAGE 4: UNCIRCUMCISED / CIRCUMCISED

Advocates for uncircumcised penises assert that the nerve endings in the foreskin and its gliding action contribute greatly to a man’s sexual pleasure. It protects and lubricates the glans, which with circumcision often becomes less sensitive over the years. In circumcised infants, they are much less susceptible to urinary tract infections. The procedure virtually precludes penile cancer and eliminates inflammation (redness and swelling) of the foreskin and glans, usually caused by poor hygiene. Studies reveal that circumcised men are at least twice as unlikely to get herpes, syphilis and HIV during unsafe sex.  However circumcision should not be used as a prevention method. 

The Testicles

IMAGE 5: TESTICLES

The testes are oval organs about the size of large walnuts that lie in the scrotum, secured at either end by a structure called the spermatic cord. Most men have two testes. Testicles are external to the body to ensure that they remain cooler than the rest of the body, providing the ideal climate for sperm production. About 90 % of testosterone, male hormones, originates in the testicles before it enters the bloodstream to travel throughout the body. Testicular cancer has the highest cure rate of any cancer when it is detected at an early stage. Monthly self-exams are encouraged and should take place after a shower when the scrotal skin is relaxed.  Gently touch and feel the testicle for any abnormalities, such as peculiar or irregular lumps. Self-examination can be a fun experience if your partner performs it for you. Obviously you could return the favour.

Pubic Hair

The function of pubic hair is:

• visual indicator of sexual maturity;
• collection of secreted pheromones;
• eduction of external friction during sexual intercourse;
• warmth (which may be a side effect).

How an Erection is Formed

An erection is the stiffening and rising of the penis, which occurs during sexual arousal, though it can also happen in non-sexual situations. The primary physiological mechanism that brings about an erection is the autonomic dilation of arteries supplying blood to the penis, which allows more blood to fill the three spongy erectile tissue chambers in the penis, causing it to lengthen and stiffen. The now-engorged erectile tissue presses against and constricts the veins that carry blood away from the penis. More blood enters than leaves the penis until an equilibrium is reached where an equal volume of blood flows into the dilated arteries and out of the constricted veins; a constant erectile size is achieved at this equilibrium.
 

IMAGE 6: ERECTION - drawing

IMAGE 7: ERECTION - photograph

IMAGE 8: PARTS OF RECTAL TRACT

TABLE 2: PARTS OF RECTAL TRACT

An individual’s sexual response is a true psychophysiological experience. Arousal is triggered by both psychological (e.g., fantasy and emotion) and physical (e.g., his gorgeous smile and big hands) stimuli; levels of tension are experiences both physiologically (e.g., heart rate increases) and emotionally (e.g., pleasant feelings); and with orgasm, there is normally a subjective perception of a peak of physical reaction (e.g., tense muscles) and release (e.g., cumming). Your psychosexual development, attitude toward sex and sexuality, and attitude towards your partner are directly linked to your sexual response. The male sexual response cycle consists of four phases:

Phase 1: Desire
Phase 2: Excitement
Phase 3: Orgasm
Phase 4: Resolution

In phase 1 (desire), a guy experiences some motivation or drive to experience sexual activity. If sexual activity is initiated, then the next three phases are likely to occur. What follows is a descriptive table of the next three phases as described by Virginia Sadock, M.D. (sourced from Kaplan & Sadock’s Synopsis of Psychiatry, 2003):

TABLE 3: Excitement, Orgasm and Resolution, per function:

A range of sexual difficulties and dysfunctions are associated with each of the different phases of the sexual response cycle:

DESIRE: Inhibited Sexual Desire (HSD); 

EXCITEMENT: Erectile Dysfunction (ED);

ORGASM: Premature Ejaculation (PE) and Delayed Ejaculation (DE).

RESOLUTION: Postcoital Dysphoria (PD); Postcoital Headache (PH).

The following section of this website (SEXUAL RESPONSE CYCLE: DYSFUNCTIONS) deals with each of those dysfunctions in greater detail.

DYSFUNCTIONS RELATED TO THE SEXUAL RESPONSE CYCLE: INHIBITED SEXUAL DESIRE

Features

• Inhibited sexual desire (ISD) refers to a low level of sexual interest. Also known as Sexual aversion; Sexual apathy; Hypoactive sexual desire (HSD).
• ISD can be primary, in which the person has never felt much sexual desire or interest.
• Secondary, in which the person used to feel sexual desire, but no longer does.
• Partner related, the person that experience ISD is interested in other people, but not in his or her partner.
• General, the person with ISD isn't sexually interested in anyone, in the extreme form of sexual aversion, the person not only lacks sexual desire, but may find sex repulsive.
• Sometimes, the sexual desire is not inhibited. The two partners have different sexual interest levels, even though both of their interest levels are within the normal range.
• In some cases a partner can claim that his or her partner has ISD, when in fact they have overactive sexual desire and are very demanding sexually.

Epidemiology

Studies have found that complaints of low sexual desire increase with age, relationship duration, number of small children, relationship discord and symptoms of anxiety and depression. The problem of sexual aversion occasionally happens in men but is much more common in women. If the problem occurs after a period of normal sexual activity, the cause can be related to a partner (because of the situation or if there is something lacking in the relationship) or might be due to some trauma or to pain caused during intercourse.

Causes

It often occurs when one partner does not feel intimate or close to the other. Communication problems, lack of affection, power struggles and conflicts, and not having enough time alone together are common factors. ISD can also occur in people who've had a very strict upbringing concerning sex, negative attitudes toward sex, internalised homophobia or traumatic sexual experiences (such as rape, incest, or sexual abuse).

Illnesses and some medications can also contribute to ISD, especially when they cause fatigue, pain, or general feelings of malaise. A lack of certain hormones can sometimes be involved. Psychological conditions such as depression and excess stress can dampen sexual interest.

Commonly overlooked factors include insomnia or lack of sleep, which lead to fatigue. ISD can also be associated with other sexual problems, and sometimes can be caused by them. For example, a man who has erection problems (impotence) or delayed ejaculation can lose interest in sex because they associate it with failure or it does not feel good.  People who were victims of childhood sexual abuse or rape, and those whose marriages or relationships lack emotional intimacy are especially at risk for ISD.

Treatment

Treatment must be targeted to the factors that may be lowering sexual interest. Often, there may be several such factors. Some couples will need relationship or marital therapy before focusing on enhancing sexual activity. Some couples will need to be taught how to resolve conflicts and work through differences in nonsexual areas.

Communication training helps couples learn how to talk to one another, show empathy, resolve differences with sensitivity and respect for each other's feelings, learn how to express anger in a positive way, reserve time for activities together, and show affection, in order to encourage sexual desire.

Many couples will also need to focus on their sexual relationship. Through education and couple's assignments, they learn to increase the time they devote to sexual activity. Some couples will also need to focus on how they can sexually approach their partner in more interesting and desirable ways, and how to more gently and tactfully decline a sexual invitation.

Most of the time, a medical exam and lab tests will not show a physical cause. However, testosterone is the hormone that creates sexual desire in both men and women. Testosterone levels may be checked, especially in men who have ISD. Blood for such tests should be drawn before 10:00 a.m., when male hormone levels are at their highest. Interviews with a sex therapy specialist are more likely to reveal possible causes.

DYSFUNCTIONS RELATED TO THE SEXUAL RESPONSE CYCLE: ERECTILE DYSFUNCTION
 

Features

Erectile dysfunction, sometimes called "impotence," is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word "impotence" may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Erectile dysfunction, or ED, can be a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.

Epidemiology

According to the Journal of Urology by A. Melman and J. Gingell, it has been estimated that the prevalence of erectile dysfunction of all degrees is 52% in men between the ages 40 to 70 years old, with higher rates in those older than 70 years. Erectile dysfunction has a significant negative impact on quality of life. Risk factors for erectile dysfunction include aging, chronic illnesses, various medications and cigarette smoking.

Causes

Since an erection requires a precise sequence of events, ED can occur when any of the events are disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.
Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of ED.  Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.  Smokers are twice as likely as nonsmokers to become impotent.  Smoking damages the blood vessels in the penis, inhibiting the healthy flow of blood that leads to an erecting.  Since these vessels are considerably narrower than those leading to the heart, the penis is even more susceptible to the serious effects of smoking.

In addition, many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug) — can produce ED as a side effect.

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED frequently experience the same sort of psychological reactions (stress, anxiety, guilt, and depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

Treatment

Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.

Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected clients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.
Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness. Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your ED prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.

PDE inhibitor drugs can only be prescribed by a doctor. Please do not use these medications before consulting with your doctor.

DYSFUNCTIONS RELATED TO THE SEXUAL RESPONSE CYCLE: PREMATURE EJACULATION

Features

Also known as rapid ejaculation, rapid climax, premature climax or early ejaculation. It is characterized by a lack of voluntary control over ejaculation.  There's no medical standard for how long it should take a man to ejaculate. The primary sign of premature ejaculation is ejaculation that occurs before both partners wish in the majority of sexual encounters, causing concern or distress. The problem may occur in all sexual situations, including during masturbation — or it may only occur during sexual encounters with another person.

Epidemiology

According to studies done in the USA the condition affects 25-40% of men. The majority of men are suffering, have suffered, or will suffer this problem at some time in their lives. It becomes a problem when it happens almost every time a man has sex. Premature ejaculation can start at any age but is most common among young, inexperienced men.

Causes

Psychological causes:

• Ongoing situations in which you may rushed to reach climax in order to avoid being discovered;
• Guilt feelings that increase your tendency to rush through sexual encounters.

Physical causes:

• Hormonal imbalance;
• Abnormal levels of brain chemicals call neurotransmitters;
• Abnormal reflex activity of the ejaculatory system;
• Certain thyroid problems;
• Inflammation and infection of the prostate or urethra;
• Hypersensitivity of the glans penis;

The principal reasons for a man being unable to control his ejaculation are anxiety, a feeling of guilt, and fear of not being good in bed.

A man who suffers from PE usually takes less time over foreplay which leaves his partner feeling that he is not fully aroused. When this happens it can increase tension between partners.

The longer it has been from when a man last had sex, the greater the likelihood of him experiencing premature ejaculation.

Treatment

Treatment options for premature ejaculation include sexual therapy, medications and psychotherapy. For many men, a combination of these treatments works best.

Sexual Therapy

• In some cases, sexual therapy may involve simple steps such as masturbating an hour or two before intercourse so that you are able to delay ejaculation during sex. The doctor may also recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from sexual encounters.

Squeeze Technique

• Step 1: Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
• Step 2: Have your partner squeeze your penis at the point where the glans joins the shaft, maintain squeezing for a few seconds until the urge to ejaculate passes.
• Step 3: After the squeeze is released, wait for more or less 30 seconds, then go back to foreplay. You may notice that the penis becomes less erected, but when stimulation is resumed, the penis will become erected again.
• Step 4: If you again feel the urge to ejaculate, let your partner repeat the squeeze technique.
  • After a few practice sessions, the feeling of knowing how to delay an ejaculation may become a habit that no longer requires the squeezing technique.

Medication

• Antidepressants
  • A side effect of certain antidepressants is delayed orgasm. This is sometimes prescribed to men with PE.  Other side effects of these medications are nausea, dry mouth, drowsiness and decreased libido.
• Topical Anesthetic creams
  • Topical anesthetic creams dull the sensation on the penis to help delay ejaculation.  Applied a short time before intercourse, these creams are wiped off when your penis has lost enough sensation to help you delay ejaculation

Psychotherapy

• This approach also known as counselling or talk therapy, and includes talking about your relationship and experiences to a mental health professional. These talks can help you to reduce performance anxiety and find effective ways to deal with stress and solving problems. 

DYSFUNCTIONS RELATED TO THE SEXUAL RESPONSE CYCLE: DELAYED EJACULATION
 

Features

Delayed ejaculation is a medical condition in which a male is unable to ejaculate, either during intercourse or with manual stimulation in the presence of a partner. Most men ejaculate within 2 to 4 minutes after onset of active thrusting in intercourse. Men with delayed ejaculation may be entirely unable to ejaculate in some circumstances (for example, during intercourse), or may only be able to ejaculate with great effort and after prolonged intercourse (for example 30 to 45 minutes).

Epidemiology

This is less common than premature ejaculation.

Causes

The most common causes for delayed ejaculation are psychological. Common psychological causes include:

• A religious background causing the person to see sex as sinful;
• Lack of attraction towards partner;
• Conditioning caused by unique or atypical masturbation patterns;
• Traumatic events e.g. learning one’s partner has cheated;
• Some factors like anger towards the partner may be involved;
• Other causes:
  • Certain drugs like antidepressants;
  • Neurological diseases like stroke or nerve damage to the back and spinal cord.

Treatment

Currently, no effective and safe drugs are available to accelerate ejaculation time in men. The best way to treat lifelong delayed ejaculation is, thus far, to inform the patients about biological and psychological inhibiting factors which they need to avoid, and to remain critical about unrealistic expectations from psychotherapy.

Psychotherapy may be useful in subgroups, particularly in the absence of effective and safe drugs.

If a man has never ejaculated through any form of stimulation (such as wet dreams, masturbation, or intercourse), a urologist should be consulted to determine if there is a congenital or physical cause.
If, however, he is able to ejaculate in a reasonable period of time by some form of stimulation, he should seek sex therapy from a therapist specializing in ejaculatory problems. Treatment usually includes both partners. The therapist will usually educate the couple about the fundamentals of sexual response and how to communicate and guide the partner to provide ideal stimulation, rather than trying to make a sexual response occur.  Therapy commonly involves a series of homework assignments wherein the couple, in the privacy of their home, engage in sexual activities that reduce performance pressure and focus on pleasure.
Typically, sexual intercourse will be prohibited for a limited period of time, while the couple gradually enhances their ability to enjoy ejaculation through other types of stimulation.  In cases where there is a problematic relationship or an inhibition of sexual desire between the couple, therapy to enhance the relationship and emotional intimacy may be required as a preliminary step.
Sometimes hypnosis may be a useful adjunct to therapy, particularly if a partner is not willing to participate in therapy. Self-treatment of this problem will probably be unsuccessful in most cases.

If a medication is believed to be the cause of the problem, other medication options may be discussed. (Never stop taking any medicine without first talking to your doctor.) This may be difficult in certain instances, especially when the medication is working appropriately to solve a pre-existing medical or psychological problem.

DYSFUNCTIONS RELATED TO THE SEXUAL RESPONSE CYCLE: POSTCOITAL DYSPHORIA
 

Features

Postcoital Dysphoria (PD) occurs during the resolution phase of sexual activity when a person normally experiences a general feeling of wellbeing, muscular and psychological relaxation. Some guys experience PE at the time and become depressed, tense, anxious, irritable and agitation after an otherwise satisfactory experience. A guy suffering from PE may experience an intense desire to get away from their partner and may become verbally or physical abusive towards their partner. But this is not limited to experiences of PE, as other guys who experience normal ejaculation may also become anxious, irritable, tense, and certain cases verbally and physically abusive towards there partner after sex.

Epidemiology

The incidence of the disorder is unknown but is more common in men than in women.

Causes

The causes of PD relate to a person’s attitude towards sex and his partner in particular. The disorder may occur in adulterous sex and in contacts with prostitutes. It may also occur in the presence of internalized homophobia. The fear of HIV can also sometimes cause PD.

Treatment

Treatment requires insight-orientated psychotherapy to help clients understand their unconscious behavior and attitudes towards sex. 

DYSFUNCTIONS RELATED TO THE SEXUAL RESPONSE CYCLE: POSTCOITAL HEADACHE

Features

This involves the sudden onset of an excruciating headache when approaching orgasm or soon thereafter. PH is believed to be a vascular headache. Since sudden rupture of cerebral blood vessels can occur, this should be evaluated by your doctor.

The duration of the headache varies from individual to individual. Sometimes it may last for a short period while in some other cases it lasts up to one day. The pain starts from the base of the skull. It may spread uniformly throughout the head too. An important thing to note is that post coital headaches are not felt after every sex act. They seem to occur at indeterminate times.

Epidemiology

PH is experienced by both men and women but the ratio of men suffering from it is higher than women. It is possible that since men remain more active during sex the possibility of them having headaches on account of sex is more.  At the same time men are also sure to have a sexual orgasm whereas that is not always true in case of a woman.

Causes

The simple reason for this headache can be understood from the fact that during sex blood pressure increases and there is a contraction of muscles in your head. If the pain is too severe there may be some underlying factor like meningitis, internal bleeding, blood clotting, tumor, stroke or other endocrine disorder. In these cases you should consult a doctor who could confirm the condition after conducting certain tests like an MRI or CAT scan.

Treatment

Although you can take an analgesic to get relief from this headache, it is recommended by experts that you seek medical assistance to get proper guidance on how to treat your PH.

Features

Priapism is a persistent, usually painful, penile erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and is unable to drain. If the condition is not treated immediately, it can lead to permanent erectile dysfunction.

There are two categories of Priapism: low-flow and high-flow:

• Low flow: This type of Priapism is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but also affects men with sickle-cell disease, leukemia (cancer of the blood) or malaria.
• High flow: High flow Priapism is more rare than low-flow and is usually less painful. It is the result of a ruptured artery from an injury to the penis or the perineum (area between the scrotum and anus), which prevents blood in the penis from circulating normally.

Epidemiology

It can occur in all age groups, including newborn babies. However, it usually affects boys between the ages of 5 to 10 years and men between the ages of 20 to 50 years.

Causes

Sickle cell anemia: Some adult cases of Priapism are the result of sickle-cell disease and approximately 42% of all adults with sickle-cell anemia will eventually develop Priapism.

• Medication
  • Some clients may use injectable medications to induce an erection. In these patients, excessive use may produce Priapism. Examples of agents used to induce an erection include papaverine, phentolamine, and prostaglandin E1.
  • Many psychotropic medications such as chlorpromazine, trazodone, quetiapine, and thioridazine have been associated with Priapism. The newer agents are not immune to this complication. Priapism has been described with citalopram, a selective serotonin reuptake inhibitor.
  • Rebound hypercoagulable states with anticoagulants such as heparin and warfarin have been associated.
  • Cocaine, marijuana, ethanol and ecstacy abuse has been cited in certain cases.
• Other causes
  • Trauma to the spinal cord or to the genital area
  • Black widow spider bites
  • Carbon monoxide poisoning

Treatment

The goal of all treatment is to make the erection go away and preserve future erectile function. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may act to decrease blood flow to the penis, may be very helpful. Other treatment options include:

• Ice applied to the penis and perineum to reduce swelling.
• Performance of surgical ligation in cases where an artery has been ruptured. In this case the doctor will “tie off” the artery that is causing the Priapism in order to restore normal blood flow.
• Intracavernous injection is used for low-flow Priapism. During this treatment drugs known as alpha-agonists are injected into the penis to reduce blood flow to the penis, causing the swelling to subside.
• A surgical shunt can be used for low-flow Priapism. A shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.
• Aspiration can also be performed after numbing the penis. Here the doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

If you suspect that you are experiencing Priapism, you should not attempt to treat it yourself. Instead seek emergency help as soon as possible.

IMAGE 9: Phimosis

Features

Phimosis is a condition where the male foreskin cannot be fully retracted over the head of the penis in uncircumcised males. The foreskin may be red, swollen, and tender.  Difficulty in urinating and ballooning of the foreskin are the commonest reasons for clients to seek treatment, though recurrent bacterial infections may also occur.

Epidemiology

Phimosis can occur at any age, however, a higher incidence is seen in infancy and adolescence.  According to studies done in the USA, phimosis affects more or less than 1% of men below the age of 16.

Causes

Phimosis is the result of repeated foreskin infections. It is linked to neglected hygiene. Germs breed under the foreskin. The delicate tissues undergo a process of partial healing/partial flare-up/partial healing again. Scar tissue keeps building up and breaking down. Eventually, the scar tissue becomes fibrous - hard, tough and inelastic. It contracts, pulling the infected foreskin tightly inwards. This adds to the spread of germs.

Treatment

• Antibiotics may control the infection. Hot soaks may help separate the foreskin from the glans. If they fail, a small incision is made to release it. Full or partial circumcision is generally advised when the inflammation clears.
• For some pliant, unscarred foreskins, a preputial stretch may be used. This can even be done under local anesthesia. Some surgeons may perform a preputioplasty, with the aim of increasing the diameter of the preputial ring but without excising the prepuce (foreskin).
• Circumcision is typically performed under general anesthesia. The foreskin is pulled back as far as it will go. It is slit along its upper surface and then all around so that it can be removed. The raw edges of the inner and outer layers are stitched, and a dressing is applied. The patient usually goes home the same day.
• Immediately after circumcision, the client may find that the appearance of the penis has changed considerably. Until healing is complete, there will be some pain but this can be controlled by painkillers. Urination may be painful and the urine should be kept away from the incision.

IMAGE 10: Prostate Cancer

Features

If the cancer is caught at its earliest stages, most men will not experience any symptoms.  Some men, however, will experience symptoms that might indicate the presence of prostate cancer, including:

• A need to urinate frequently, especially at night;
• Difficulty starting urination or holding back urine;
• Weak or interrupted flow of urine;
• Painful or burning urination;
• Difficulty in having an erection;
• Painful ejaculation;
• Blood in urine or semen; or
• Frequent pain or stiffness in the lower back, hips, or upper thighs.

Epidemiology

Prostate cancer is uncommon in men younger than 45 years of age, but becomes more common with advancing age. The average age at the time of diagnosis is 70 years. However, may men never know they have prostate cancer. According to autopsy studies done on Chinese, German, Israeli, Jamaican, Swedish and Ugandan men who died of other causes, it was found that 30% of men in their 50’s and 80% of men in their 70’s had prostate cancer. According to studies done in the United States in 2005, there was an estimated 230 000 new cases and 30 000 deaths due to prostate cancer.

Causes

The specific causes of prostate cancer remain unknown. A man’s risk of developing prostate cancer is related to his age, genetics, race, diet, lifestyle, medications and other factors. The primary risk factor is age.

Treatment

• Closely monitoring of client’s condition without any treatment until symptoms appear or change. This is used in older men with other medical problems and early stage cancer.
• Clients in good health are usually offered surgery as treatment for the prostate cancer.  Different types of surgery are available.
• Radiation therapy is a form treatment that uses high-energy x-rays or other type of radiation to kill cancer cells and prevent cancer cells from growing. Males may experience impotence and urinary problems due to radiation therapy. There are two types of radiation therapy:
  • External radiation: use of a machine outside the body to send radiation towards the cancer.
  • Internal radiation: use of radioactive substances that are placed directly into or near the cancer site.
  • Hormone therapy: removal of hormones or blocking their action to stop cancer cells from growing.
  • New types of treatment are being tested in clinical trials.

IMAGE 11: Testicular Cancer

Features

Symptoms may include one or more of the following:

• A lump in one testis or a hardening of one or both of the testicles.
• Abnormal sensitivity e.g. numbness or pain.
• Decrease in libido.
• Sexual withdrawal.
• Build-up fluid in the scrotum.
• Dull ache in the lower abdomen or groin.
• A significant increase or decrease in the size of one testis. A testicle with a tumor may be severely enlarged (as much as 3 times the original size). Simultaneously the other testicle may be shrunken in size due to the fact that the tumor is taking the majority of the blood supply.
• Blood in semen.
• Generally weak and tired (malaise).
• A testicle mass can be palpated and may be an early sign. Because of the success rate of testicular cancer, early detection is vital. It is suggested that men should perform a monthly examination on their testes after a hot bath/shower when the testes are looser. Feel for pea-shape lumps or any suspicious changes.

Epidemiology

Although malignant testicular cancer is a quite rare, its medical importance is growing due to a rapid growth in incidence. Incidence has increased by 80% in the period 1968–2003. Diagnostic and treatment delay may have an impact on overall survival. The best chance of decreasing mortality is early detection.

Causes

• The causes of testicular cancer are unknown, but the number of men who develop testicular cancer is increasing and research is being conducted to explore why.
• Men born with an undescended testicle (one that remains in the abdominal cavity rather than descending into the scrotum) may be at greater risk of developing testicular cancer.
• Other factors that are thought to make testicular cancer more likely include:
  • having a brother or father who had testicular cancer;
  • pre-existing fertility problems;
  • being white rather than of African or Asian descent;
  • having a rare complication of mumps called orchitis (painful swelling of the testicles).
• Having a vasectomy or injury to the testicles does not cause testicular cancer.

Treatment

The tree basic treatments for testicle cancer are:

• Surgery
• Radiation therapy
• Chemotherapy

Features

• The most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often the lump is painless.
• Other male breast cancer symptoms include:
  • Skin dimpling or puckering;
  • Development of a new retraction or indentation of the nipple;
  • Changes in the nipple or breast skin, such as scaling or redness;
  • Nipple discharge.

Epidemiology

Breast cancer isn't just a woman's disease. Men also have breast tissue that can undergo cancerous changes. While women are about 100 times more likely to get breast cancer, any man can develop breast cancer. Male breast cancer is most common between the ages of 60 and 70.

The prognosis for male breast cancer is the same as for breast cancer in women. In the past, male breast cancer was often diagnosed at a more advanced stage, which may have led people to believe it had a worse prognosis. Although male breast cancer and breast cancer in women are similar, important distinctions such as breast size and awareness affect early diagnosis and survival in cases of male breast cancer.

Causes

In most cases it isn't clear what triggers abnormal cell growth in breast tissue in men. But doctors do know that about one in six cases of breast cancer in men are inherited, compared with about 5% to 10% of breast cancer in women. Other inherited genes also may increase your risk of developing breast cancer. Knowing your family history is important to determine your chance of inheriting an abnormal gene. Other factors include:

• Age;
• Family history and genetic predisposition;
• Radiation exposure e.g. chest x-rays during childhood;
• Exposure to estrogen e.g. hormones taken during sex changes and prostate cancer;
• Liver disease;
• Excess weight’
• Excessive use of alcohol;

Treatment

The tree basic treatments of breast cancer are:

• Surgery
• Radiation therapy
• Chemotherapy

Features

The symptoms of anal cancer are not unique and are also symptoms of other conditions, such as hemorrhoids. Although anal cancer is relatively simple to diagnose, there is often a delay in diagnosis because of a misdiagnosis.

Symptoms of anal cancer include:

• Lumps or bumps located near the anus;
• Anal bleeding or bleeding during bowel movements;
• Anal discharge;
• Pain in or around the anus;
• Itchy sensation around or inside the anus
• Change in bowel habits, such as constipation, diarrhea and the thinning of the stools

Epidemiology

Anal cancel is not common, although an increased incidence has been associated with infection with human papilloma virus (HPV), lifetime number of sexual partners, genital warts, cigarette smoking, receptive anal intercourse, and infection with human immunodeficiency virus (HIV).

Causes

While the exact cause of anal cancer is not known, most anal cancers appear to be linked to infection with the human papilloma virus (HPV). While HPV infection seems to be important in the development of anal cancer, the vast majority of people with HPV infections do not get anal cancer.

Most people know that smoking is the main cause of lung cancer. But few realize that the cancer-causing chemicals in tobacco smoke can travel from the lungs to the rest of the body. Many studies have noted an increased rate of anal cancer in smokers, and the effect of smoking is especially important in people with other risk factors for anal cancer.

The following risk factors can contribute to anal cancer:

• Being over 50 years of age;
• Practicing receptive anal sex;
• Having many sexual partners;
• Being infected with HPV;
• Abnormal opening in the anus (fistulas);
• Frequent anal redness, swelling and soreness;
• Smoking cigarettes.

Treatment

The tree basic treatments of anal cancer are:

• Surgery
• Radiation therapy
• Chemotherapy

Prostate Examination 

IMAGE 12: Prostate Examination

Given that men above the age of 45 are at high risk for developing Prostate Cancer, men 45 years and above should go for a regular prostate examination. The procedure can be performed by your doctor or an urologist. The procedure is as follow:

• The patient is advised that a finger will be inserted into their rectum in order to examine the prostate gland.
• Usually the patient is asked to stand, feet apart, facing the examination bed and bend forward so that his arms or elbows are on the bed.
• The doctor will put on a surgical glove and will cover a finger in lubricant.
• The doctor will inform the patient that he will feel a little pressure but no discomfort.
• The finger will be inserted in a downwards angle as if pointing to the umbilicus (belly button).
• A few seconds may elapse as the doctor waits for the external sphincter muscle to relax.
• The patient will become aware of some movement of the finger before it is removed.
• When the examination is complete, the doctor will inform the patient that s/he will remove their finger, and then offer the patient some tissue to wipe the lubricant from the anus and buttocks.

If you are above the age of 50, your doctor should offer you a PSA (Prostate Specific Antigen) blood test. A prostate examination should be performed yearly in patients with previous abnormalities or are considered at high risk. In cases where no abnormalities have been detected, an examination is recommended every 3 years.

Testicular Examination

Although malignant testicular cancer is a rare, early detection is vital for a good prognosis. It is suggested that men should perform a monthly examination on their testes after a hot bath/shower when the testes are looser. Feel for pea-shape lumps or any suspicious changes. If you experience any abnormalities you should go for a medical examination with your Health Care Practitioner.

Rectal Examination

Due to the fact that Gay men are more exposed to the Human Papilloma Virus (HPV), which contributes to the development of anal cancer, gay men should perform a regular rectal examination starting at age 40. This examination should be performed every 3 years if no abnormalities were found during the first examination. High risk clients, having a family history of cancer, should go for yearly examinations. The examination can be performed by your family doctor. The following can be expected:

• The patient is positioned comfortably in the left lateral position (lying on your left side). The patient is asked to flex his hips and knees and position his buttocks at the edge of the examination bed.
• The buttocks are gently parted to expose the anal verge and natal cleft.
• Inspection of the skin and anal margin will be performed with a light for proper examination.
• The examining index finger will be lubricated with a suitable water-soluble gel and the finger will be pressed against the posterior anal margin.
• The examining index finger will slip easily into the anal canal, and the finger tip is directed posterior following the sacral curve.
• At this point, if appropriate, the anal tone can be checked by the doctor asking the patient to squeeze the finger with the anal muscles.
• The finger is then moved through 180° feeling the walls of the rectum.
• When the examination is complete, the doctor will inform the patient that s/he will remove their finger, and then offer the patient some tissue to wipe the lubricant from the anus and buttocks.

Rectal Pap Smear

A rectal pap smear should be performed by your doctor at the age 40 and repeated every 3 years if no abnormalities were found during the first examination. High risk clients, having a family history of cancer, should go for yearly examinations.  In the case of your doctor suspecting the presence of Human Papilloma Virus (HPV) or anal warts, a rectal pap smear might also be indicated.  The following should be done 24 hours prior to your anal pap smear:

• Bath or shower just before going to your doctor, making sure you gently washed your rectal and perineal areas with mild soap and warm water.
• Avoid anal receptive sex 24 hours before your examination.
• Don’t apply any creams, soaps, lubricants or medication into your anus 24 hours before your examination.
• Don’t insert sex toys or other objects into your anus 24 hours prior to your examination.
• Don’t douche or use an enema before the procedure.

The following can be expected during your anal pap smear:

• With you in a position that offers access to your rectal area, the doctor will insert a swab into the anus.
• The swab will be gently rotated by the doctor to contract the inner mucosal surfaces of the anal canal.
• The swab will be removed after collecting a few thousand mucosal cells and placed in a special laboratory transport vial. The cells will be examined in a lab under a microscope.  Results usually take + 2 weeks.
• The anal pap screening is a simple, painless, and quick procedure that takes a few minutes to complete.
  You may experience a little rectal bleeding after the examination but the procedure is usually quick and for the most part painless.

The prostate examination, rectal examination and anal pap smear can be combined in one procedure.

Breast examination

Due to the fact that men can also get breast cancer, it is suggested that men should perform a self evaluation on a monthly basis.  The following method can be used for self examination:

• Inspect your breasts in the mirror for dimpling, swelling or redness. Squeeze the nipples gently to check for any discharge.
• Do the following while you are in the bath or shower:
  • Put soap on your hand, put your one hand behind your head, and gently palpate (massage) your armpits in circular movements.  Feel for any lumps or nodules present.
  • After examination of your armpit, move to the breast area in circular movement starting with big circles and then going smaller.
  • End at the nipple, but don’t forget to palpate the nipple.
  • Repeat the procedure with the other armpit and breast.
• If you note any abnormalities, contact your doctor for an evaluation.

Benefits

• Exercise improves your mood;
• Exercise improves your fight against chronic illnesses;
• Exercise plays an important role in weight management (which is a preventative health benefit);
• Exercise strengthens your heart and lungs;
• Promotes sleep and rest;
• Exercise can put a spark back into your sex life;
• Exercise can be fun and a great way of relieving stress and tension.

Minimum

The minimum requirement is 2-3 times per week, for at least 30 min at a time. Make sure to warm up before starting.

Benefits

Your body is only as healthy as the fuel it's given. Rubbish in, equals rubbish out. Without adequate nutrition, the body will not be able to function optimally, including sexually. This can mean poor concentration, low energy levels, and low immunity (which means an increased risk of more illnesses). Skin, hair, teeth, bones and muscles will not be as strong and healthy as they could be. And all your ‘tools and parts’ may begin to malfunction. 

Overeating does not necessarily mean that the body is getting all the essential nutrients it requires. Quite often unhealthy food is substituted for essential nutritious food, and so overweight people are at increased risk of suffering from poor nutrition (not to mention the physical burden of excess weight and the increased risk of other chronic illnesses).

Being overweight is a health problem as it increases the risk of heart disease, high blood pressure, diabetes and several cancers. Added to this, being overweight can limit movement and in this way it can reduce social interaction, which is necessary for emotional wellbeing.

Minimum

IMAGE 13: Food Guide Pyramid

The Food Guide Pyramid is an outline of what to eat each day based on dietary guidelines. It's not a rigid prescription, but rather a general guide that lets you choose a healthy diet that's right for you.

What Counts as One Serving?

• Milk, Yoghurt and Cheese group
  • 250 ml yoghurt or milk = 1 serving
  • 25 g cheese = 1 serving
• Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts
  • 55-85 g cooked lean meat, poultry, or fish = 1 serving
  • ½ cup cooked dry beans = 1 serving
  • 1 egg = 1 serving
  • Handful of nuts = 1 serving
• Vegetables group
  • 1 cup of raw leafy vegetables = 1 serving
  • ½ cup of either carrots, beetroot, corn and pumpkin = 1 serving
• Fruit group
  • 1 medium fruit e.g. apple, banana or orange = 1 serving
  • ½ chopped, cooked or canned fruit = 1 serving
  • ¾ fruit juice = 1 serving
• Bread, Cereal, Rice, and Pasta group
  • 1 slice of bread = 1 serving
  • 50 g ready to eat cereal = 1 serving
  • ½ cup of cooked cereal, cooked rice or cooked pasta = 1 serving

Benefits

Stress is the ‘wear and tear’ your mind and body experiences as you attempt to cope with a continually demanding and changing environment. Excessive, prolonged and unrelieved stress can have a harmful effect on your mental and physical wellbeing. If unresolved or left unmanaged, it could trigger a variety of harmful lifestyle choices, and ultimately, ill-health. But not all stress is negative. Some stress can have a positive effect by ensuring motivation and awareness, and providing stimulation needed to cope with challenging situations. Irrespective of the nature of the stress, it is vital to your complete wellbeing that you manage your stress. The benefits of this include:

• Improved sleep patterns and quality of sleep;
• Increased physical and mental energy;
• Improved sexual drive;
• Improved concentration and memory;
• Improved sense of control over your life;
• Improved appetite and quality of nutrition;
• Decrease stress related health problems e.g. heart attacks;
• Improved appreciation for life and others around you;

Strategies and Tips

You can start by following these easy tips and strategies:

• Slow down your breathing – Inhale and exhale slowly and deeply (e.g., inhale for a count of 5, hold, and then exhale for a count of five).  This works in two ways – it settles your energy and takes your focus away from the stress and anxiety provoking trigger. This is a very effective method to start with.
• Distance yourself - Imagine that you are watching yourself as someone else would, with friendly curiosity. Observe, uncritically, your emotions and sensations and reactions. This creates distance between you and your stress and helps you to take control and manage your stress – instead of the other way around!
• Press your feet into the floor - By doing this you shift your focus away from your mind (and the stress) and into your body. Imagine that you are a tree and your feet are the roots. “Plant” yourself firmly and blow tension out of your roots into the ground. Breathe in calm energy from the ground back up through your roots.
• Laugh - Be humorous!  Laugh at yourself and the stress! Laugh at the stress! Everyone can benefit from a bit more laughter. 

Other strategies for managing your stress:

• Surround yourself with fun, positive and uplifting people;
• Hit the gym;
• Watch your diet (reduce your intake of caffeine, alcohol, nicotine, sugar, salt, and fat);
• Pamper yourself by going for a massage now and again;
• Take up Tai-chi or Yoga.

Effect of alcohol and drugs on sexual health

• Alcohol and drugs lowers your inhibitions and interferes with your decision making, often resulting in unprotected sex.
• Alcohol and drugs interfere with your ability to enter into a safer sex negotiation.
• Alcohol and drugs usually result in poor sexual performance but can have the opposite effect – change in sexual performance.
• Alcohol and drugs generally create serious relationship problems;
• Alcohol and drugs can have serious financial implications;
• Alcohol and drugs generally reduce immune system functionality, which increases your vulnerability.

Strategies and tips to reduce harm

Reduce frequency of drugs and alcohol use.

• Stop taking drugs and alcohol when having sex.
• Avoid friends and places where you might be tempted to use excessive drugs and alcohol.
• Ensure safer sex negotiations.
• If you are injecting, use clean water and don’t share equipment.
• Regular health check-ups and HIV Testing, at least every 6 months.
• Be faithful to one partner or reduce partner turn-over.
• Always carry condoms and lube with you (e.g., Play safe pack).
• Avoid places where you might be tempted to have high risk sex e.g. dark rooms.

PREVENTION

Strategies: condoms, lube, dental dams, gloves, testing, self-exploration, knowledge, communication about sexual histories, safer sex negotiation (Go to SAFETY ZONE section of this website for more information on this).