below   the belt

Problems "down there" are not confined to women. Among the most common male woes concern the prostate and impotency.

urinary problems Recently my husband has started waking up to urinate as much as four times a night. He never used to. Should we be concerned? Waking up four times a night is certainly very disruptive for anyone, and you should rightly be concerned. The most likely cause is an enlarged prostate and age-related changes in the bladder. Less likely causes but equally important are urine infection, bladder stones, or any medication he might be taking, for instance some diuretic medication for high blood pressure. Your husband’s problem should be checked early, so do get him to seek medical advice as soon as possible. As part of the regular health checkups, questions relating to urinary symptoms will be asked. If there is any concern about enlarged prostate from Benign Prostatic Hyperplasia (see next page), or even suspicion of prostate cancer, then the appropriate referral to a urology specialist will be made. The urologist will decide on all the tests and checkups necessary. "Based on local studies, roughly 30-40 per cent of Singaporean men above 50 will have some lower urinary tract symptoms to varying degrees. However, only 20-30 per cent have actual urinary impairment from Benign Prostatic Hyperplasia, or BPH. The average age group at our clinic for BPH is 60-65 years." – Dr Chong Tsung Wen, Consultant, Department of Urology, Singapore General Hospital

erection problems We have been married for five months and my husband, 28, has never had a strong enough erection for penetration. Help! It is very rare for a 28-year-old man to have problems with erection. If this is the case, he may have problems with the blood vessels in the penis. Or there could be nerve, hormone or structural problems with it. Apart from the cause being "organic", it could also be "psychogenic". A "psychogenic" cause means there is a psychological component. Patients can receive medical treatment and be slowly weaned off their medications once their erection and confidence have improved. "Organic" means they have actual physical problems or disease that would cause impairment to their erection. As a wife, you can help by encouraging him to see a family physician or a urology specialist for assessment and treatment. "Some couples have sexual intercourse once a month, some every day. So long as they are happy with their own particular situations, it would be considered "normal". Problems arise when one partner has higher sexual needs than the other. This might lead to stress in the sexual relationship, which might extend to the marriage. It is important for every couple to find the balance in their marriage, and this takes lots of communication, accommodation and, sometimes, compromise." – Dr Ng Kok Kit, Associate Consultant Urologist, Changi General Hospital

below the belt impotency

the facts • Erectile dysfunction (ED), or to use the common term impotency, means an erection whose duration and rigidity is insufficient for successful penetration. ED is not the only sexual problem. There’s also premature ejaculation (the man can initiate an erection, but ejaculates too fast, meaning before penetration), and libido problems, which relate to the desire for sexual intercourse. • The incidence of ED increases with age – the prevalence can be as high as 60 per cent at the age of 70 years old. • It is not that the problem of ED has increased but rather that awareness of the problem has increased. Men now more readily and actively seek treatment for ED. Also, as men become healthier and live longer, it follows that the incidence of ED will increase as the condition is age-dependent. • There are no studies indicating that men in any particular professions are more at risk of ED. However, a high level of stress would not be conducive to erection or sexual intercourse. It is essential that sexual intercourse be performed in an atmosphere of intimacy and in a stress-free environment. ED and infertility Failure to sustain an erection of sufficient rigidity and duration would lead to failure of sexual intercourse. This in turn would lead to male infertility or, to use the preferred term, subfertility. Causes of subfertility from ED include congenital (inborn) causes and acquired causes, like mumps viral infection. Other causes include drugs, radiation and injury to the testes. Or, sometimes, sperm quality might be impaired due to injury.      Typically, the male factor is responsible for 30 per cent of subfertility, the female factor another 30 per cent and combined male and female factors 40 per cent. This indicates that male infertility directly or indirectly accounts for 70 per cent of infertility cases.       It is important in the evaluation of infertility that the couple be assessed together. fertility check To check for fertility, a few specimens of seminal analysis, in other words the assessment of his sperm samples, are done. Blood tests which check whether he has got any hormonal imbalance are also performed.      Some patients may have a condition called varicocoele, or enlarged veins in the scrotum. Operating on the varicoele (called varicocoelectomy) might help to improve the sperm quality. Some conditions where the sperm transport is obstructed can be treated surgically. These procedures are done on the man alone.      Assisted Reproductive Techniques (ART) require both the man and the woman to be involved. These include artificial insemination, and they form another option for treatment.      Generally, the couple is advised to try for a year before taking other steps to have a child. However, if the couple is of more advanced age, especially for the female, they should seek help earlier. The couple can be advised on ART. They can also consider adoption.

essential things to know about the prostate 1 The human prostate is a sex accessory tissue beneath the bladder at the bladder outlet, where urine flows into the urethra. Its size varies with age. The prostatic secretions form a major part of the ejaculate containing many biologically active substances, but to date there is limited knowledge of the actual physiological significance of these secretions. 2 Benign prostatic hyperplasia, or BPH, refers to the age-related growth of the prostate gland in all males (usually after 50), and is dependent on the male hormone testosterone to drive growth. Hyperplasia means the number of cells in the prostate is increased in response to testosterone. Growth begins at puberty, and ends when the main source of testosterone (the testes) is removed through medication, surgery (castration) or decline in testosterone levels with ageing. 3 Treatment of BPH is mainly either by oral medication or surgery. The main operation for BPH is Transurethral Resection of the Prostate (TURP). This is endoscopic surgery (no cutting on the skin) to resect the central part of the prostate gland that is causing obstruction. The patient is admitted on the day of surgery itself. Most operations last between 30-60 minutes, and patients can go back to a full diet that same evening. Discharge from hospital is expected by the 2nd to 3rd postoperative day. Patients are advised not to strain themselves for up to a month, but light exercise like walking is encouraged. The operation physically reduces the size of the prostate, but does not prevent re-growth of the gland, which can sometimes cause problems many years later. There are medications that slow down prostate growth, but these are not routinely prescribed after surgery. 4 There is currently no evidence that BPH leads to prostate cancer.

 With its state-of-the-art facilities and procedures, the Department of Urology at Singapore General Hospital offers a broad range of services in shockwave lithotripsy, endourology, laser surgery, uro-oncology, female urology, andrology, reconstructive urology and renal transplantation. Call 6222-3322( main line) or visit www.sgh.com.sg.

The Department of Urology at Changi General Hospital offers a comprehensive range of services for the evaluation, diagnosis and treatment of acute and chronic urological conditions, as well as state-of-the-art diagnosis and treatment of erectile dysfunction and male infertility. Call 6850-3333 or visit www.cgh.com.sg/medical/urology.asp.