Don’t be one of the 80% of men who’d rather be ill than admit to a problem
IS the cliche true — are men reluctant to talk to doctors about their health? Surveys paint a depressing picture: up to 80 per cent of men questioned by a health insurer recently said they would rather endure an illness than seek help. I’d say two-thirds of my patients, generally, are women. There are many reasons for this.
Women are more used to seeing doctors, having often gone through the process of having a baby, with all the check-ups and visits that involves before, during and for years after. Regular screening for cervical cancer, from their mid-20s, and breast cancer in middle age, is another reason.
And, no doubt, some men feel pressure to ‘be a man’ and not talk about their problems. Nowhere is this more apparent than with ‘embarrassing’ ailments.
‘Physical stuff around genitals is something most guys will find difficult to talk about,’ says Jim Pollard from the Men’s Health Forum. ‘These things are tied up with notions of masculinity — and men don’t like sitting in a doctor’s surgery admitting they don’t know what’s wrong.’
The key thing to remember, as Dr Kaye has already pointed out on the previous pages about women’s health, is that we GPs have seen all of this before. Men can, and do, come and see me all the time with these things — and, of course, if you’d rather speak to a male doctor, we understand that.
In the meantime, here is my guide for dealing with the male ailments you might be shy to talk about — but really needn’t be.
THE QUESTION MEN MOST ASK GOOGLE BUT NOT ME
IT IS, according to search-engine data, one of the most frequently asked questions relating to male sexual health: What are the spots on my penis?
Sexually transmitted infections are common, but also easily sorted. However, I often see a patient who’s worried himself unnecessarily — or worse, tried to selftreat — when the problem is entirely benign.
WHAT CAUSES IT?
Small raised bumps along the shaft of the penis that are pale red, yellow-white or skin-coloured are usually what we call Fordyce spots or granules.
They can also appear on the scrotum, and the lips, but they are totally harmless oil-secreting glands in the skin, and there is no reason to do anything about them.
There are loads of home-remedies for sale on the internet, but these at best do nothing and at worst damage the skin. Avoid them.
Small white spots around the head of the penis, known as pearly papules, are also totally harmless and about a third of men have them. It’s also not unusual to get small red pimples, known as septic spots, which just go away after a week.
Genital warts are common — about 57,000 men get them each year. The colour depends on your skin shade but the characteristic appearance is of a ‘wobbly’ projection — like a tiny strand of seaweed. They are caused by the human papillomavirus, or HPV, which is also linked with cervical, throat and anal cancers.
Genital warts are highly infectious and can be passed on through sex.
Spots which are more like ulcers — but are usually painless — may be syphilis, a sexually transmitted infection (STI) which can also cause a rash on the hands and feet.
I know Dr Google may have diagnosed penile cancer, which is linked to the HPV virus, but this affects only 20-25 men a year in Ireland.
WHAT CAN I DO?
Your GP, or a sexual health clinic, will be able to test you for STIs and prescribe treatment — antibiotics for syphilis and a cream or minor surgery to burn, laser or freeze off genital warts. And if you are treated, and symptoms persist, go back to the doctor.
MYSTIFYING SCAR TISSUE CAUSING SEX PROBLEMS
Most men will worry at some point that their penis isn’t ‘normal’, but it’s time to take note if there’s an obvious change — a more noticeable bend, for example, or even an hour-glass shape. This could be a sign of the usually harmless condition Peyronie’s disease. Normally only noticeable when erect, if any of these are accompanied by painful erections or erectile dysfunction then it should be checked out.
WHAT CAUSES IT?
Experts are still a bit stumped, but the change of shape is the result of scar tissue, or plaques, developing within the shaft. In some cases it happens following an injury sustained during sexual activity.
It’s also relatively common, affecting up to one in ten men, and is most prevalent in those aged 50 and over. It might also run in families. While not harmful, it can be emotionally distressing, particularly if it affects sexual relationships, which can take a huge toll on mental health.
WHAT CAN I DO?
It can improve all by itself. But take advice from a GP or sexual health clinic. There are some potential treatments, including injecting steroids or using ultrasound therapy, but there is only limited evidence this works.
If the change in shape is severe and makes intercourse impossible, for instance, surgery to cut away the plaque or implant a device to straighten the penis is available as a very last resort.
Consultant urologist Asif Muneer tells me some patients find it easier to take pictures of the problem to save embarrassment when they seek help. ‘When I started, people were bringing in out-of-focus Polaroids,’ he said. ‘Now, thanks to mobile phone cameras, I can get a better idea of the problem.’
WHEN THE LOCATION OF A LUMP IS EVERYTHING
A LUMP in the testicles doesn’t always mean cancer, despite what Dr Google might suggest.
For every 100 men who find such a growth, 96 will discover it has a completely harmless cause. And often it might not even need any treatment at all.
Any change should be checked out straight away by a doctor, but there are a whole range of benign conditions that it’s more likely to be than cancer.
WHAT CAUSES IT?
Thrush is not just a girl thing – men can get it too, causing irritation of the penis and discharge
Any lump behind or on top of the testicle might be an epididymal cyst — a harmless growth filled with liquid. It’s more common in the over-40s and rarely needs treatment. This is diagnosed by a doctor shining a special light through the scrotum. If it’s an epididymal cyst, the light will shine through the liquid, if it is cancer, it won’t.
Other common lumps include varicoceles, distended veins just like varicose veins in legs, and hydroceles, which involve fluid accumulating around the testicle.
Men are far more likely to disclose their embarrassing health complaints to a female GP
An infection known as epididymo-orchitis, which causes the testicles to become painful and swollen, is the only issue that may need treatment with antibiotics.
But Robert Cornes, a specialist nurse at male cancer charity Orchid, says that as a general rule of thumb, any small, hard lump attached to the testicle should be checked in case it’s an early sign of testicular cancer.
WHAT CAN I DO?
While most lumps will be benign, do see a GP, urges Mr Cornes. ‘A quick examination will tell us what’s going on and, if not, an ultrasound on the testicle will be about 99 per cent accurate.’ It’s worth remembering, too, that testicular cancer is one of the most treatable cancers if caught early.
WHAT CAUSES THOSE MOOBS TO GROW?
WEIGHT gain around the chest area — sometimes described as ‘man boobs’ or ‘moobs’ — affects as many as 70 per cent of men over the age of 50.
WHAT COULD IT BE?
The clinical name is gynaecomastia and it’s generally harmless. But it can be uncomfortable and lead to feelings of depression and isolation. It generally develops because of a hormone imbalance between testosterone and oestrogen. When men pile on the pounds later in life, the extra body fat leads to a rise in oestrogen.
Testosterone levels, which normally keep oestrogen in check, also drop with age. Both can cause breast tissue to develop. In rarer cases it might be a symptom of liver cirrhosis, testicular cancer, kidney failure or an overactive thyroid, or a side effect of medication for an enlarged prostate or anti-psychotic drugs.
WHAT CAN I DO?
Most men won’t need to seek treatment. Losing weight can help. In some cases, usually in men who are otherwise slim, drugs can help suppress excess oestrogen.
NIGHT TIME TOILET TRIPS COULD BE A WARNING
STUMBLING to the toilet in the middle of the night is nothing unusual, especially after a couple of pints. It’s often linked to advancing years and will, most likely, worsen with age.
But if it’s regularly happening several times a night, the need becomes more urgent, and if it’s affecting the quality of sleep, then it might be worth going to see a GP.
WHAT COULD IT BE?
There is a good chance it’s nothing more than an enlarged prostate — the walnut-sized gland underneath the bladder which produces semen. It is a completely normal side effect of ageing.
However, it puts additional pressure on the bladder, which causes men to feel the need to urinate more frequently. Men might worry that this means they’re at an increased risk of prostate cancer, but this isn’t true. What is important is that the symptoms are checked to rule out prostate cancer, which affects one in seven men.
WHAT CAN I DO?
Orchid nurse Robert Cornes says: ‘Your GP should refer you to a consultant urologist.’ This appointment may require a rectal examination, and a blood test known as a PSA test which, although unreliable, can suggest whether cancer is more likely. Treatment for an enlarged prostate can include simple lifestyle changes, such as drinking less alcohol and caffeine, and exercising more. Medication can reduce the size of the prostate and relax the bladder, but in more serious cases surgery may be recommended. Even if the prostate is cancerous it might not need aggressive treatment as generally the tumours grow slowly.
THE INTIMATE INFECTION YOU SHOULDN’T IGNORE
DISCHARGE from the penis, outside of sexual activity, is never normal. If you notice this, it’s probably the sign of an infection. Such infections are very easy to treat, so see a doctor.
WHAT CAUSES IT?
White discharge indicates chlamydia. It is passed on through unprotected sex. It may be accompanied by pain when urinating or painful testicles. Green discharge is a sign of gonorrhoea.
WHAT CAN I DO?
Both conditions are treated with antibiotics. Don’t have unprotected sex as these infections can seriously affect a woman’s fertility.