TALKING HEALTH IN G MEN’S MOVEMBER
MOVEMBER - a combination of the words ‘mo’ustache and ‘No’vember - is an annual global event originating in the land down under, Australia, where men grow moustaches during the month of November to raise awareness of men’s health issues.
As part of the awareness drive locally, Dr Vincent Gothaloganyamang Molelekwa - a specialist obstetrician, gynaecologist, super specialist in fertility medicine as well as a certified endoscopic surgeon - will be a guest speaker at the upcoming sexual health event ‘Just Sex’ slated for Friday 18th.
The passionate physician speaks to Voice Woman about his illustrious career, men’s health and issues of fertility, subfertility and infertility.
Give us a brief background of your career…
I started at Goo-tau Primary School in 1978 and proceeded to Moeng College, followed by 3 years at UB, beginning with the pre-entry science course, then two years of BSC. In 1993, I graduated with 4 degrees from the University College Dublin in Ireland, where I read medicine and immediately started my training in obstetrics and gynaecology.
I qualified as an obstetrician and gynaecologist in 2006 by being admitted in the Royal College of Obstetricians and Gynaecologists (UK) and The Royal College of Physicians of Ireland. I returned to Botswana in 2007 to work at Marina as an obstetrician and gynaecologist. In 2010 to 2014, I worked as Princess Marina Superintendent and doubled as Deputy Permanent Secretary in the Ministry of Health from 2013 to 2014. I then went for subspecialty training in Cape Town as a fertility specialist. To that extent, I hold a fellowship in Fertility Medicine from the Colleges of Medicine of South Africa and Master of Philosophy in Reproductive Medicine from Stellenbosch University. I returned to work at Marina as a fertility specialist in May 2016, and left Marina to work as a private fertility specialist in March 2017 where I have been since.
Why this specific field?
Since I was 10 years old in Standard 4, I had always wanted to become a medical doctor, a need necessitated by seeing my grandma, mother and father suffering from multiple maladies and the wish to see them well someday. But sometime around 1986-7, two of my sisters had to undergo gynaecology surgeries in South Africa, at that time citing lack of local expertise. I was doing Form 3 at that point and I enquired what speciality was lacking and I was informed OBYGN. It was then that I became an Obstetrician and Gynaecologist!
November becomes Movember where men grow a moustache for 30 days, turning into walking, talking billboards for men’s health. Is there enough awareness on men’s health in Botswana?
Unfortunately, there isn’t enough awareness on issues of men’s health for two reasons. First, because men themselves often have a cavalier attitude about health issues. The other reason is because most men live in villages, cattle posts and their fields where there is lack of opportunities to learn about their health.
Do you not see a lot of male patients then?
I have a substantial number of male patients attending the clinic for a variety of reasons ranging from fertility, sexual dysfunction to general health. One of the most important well-established ways to break the cycle of self-neglect among men is through a well-thought-out health education programme driven centrally. This would require re-orienting our health services to directly target our men, crafting relevant public policies to address men’s health issues, community mobilisation and providing an enabling or supportive environment conducive for men to both learn and taken responsibility for their health.
You are very passionate about your job, who should visit your clinic?
Both men and women: fertility clinic addresses all the fertility requirements of a population. However, more often than not, the frequent visitor to the clinic is the female, often so because of societal expectations and the view by men that they play no role in the infertility status of the couple in question.
Does that mean fertility is still a taboo topic in Botswana?
It is one of the most stigmatised health conditions. Sufferers suffer in silence. It brings shame, helplessness, depression and in some cases battering.
What affects ‘normal’ fertility in men?
There are many things that may go wrong in both sexes. In both males and females, there may be an imbalance in the hormones that regulate reproduction produced by the pituitary gland in the brain.
In males, the environment plays an important role in infertility. Too much caffeine, alcohol, smoking, street drugs and lack of certain nutrients in the diet such as zinc, folic acid, vitamin A, B, C, D and E directly harm fertility in males. Certain environmental factors such as derivatives of the petrochemical industry directly affect male fertility. These agents are found in pesticides and herbicides. Hence males are likely to eat these from commercial farm produce. Equally important, these agents can be found as food preservatives… and, in the cosmetic industry, they can be found in our soaps, bath foams, hair conditioners, shower gels, skin care products, roll-ons and perfume. Other equally important environmental factors include paint in the building industry and car exhaust fumes, especially in men working in closed garages.
Men must also be aware that male obesity does cause infertility, as does too much heat around the testes such as in wearing tight pants, cycling long distances, driving trucks over long distances or bathing using unusually hot water.
Men with medical conditions such as high blood pressure, diabetes, spinal cord injuries, varicocele (a bag of veins in the scrotum), hydrocele (a bag of water around the testes), hypospadias (a bent penis), undescended testes, blocked spermatic tubes,
prostate infections, genetic diseases and the like, are all vulnerable to infertility.
Another important cause of male and female infertility are medications or treatments given to men for the treatment of different medical conditions. These could be in the form of cancer treatments such as chemotherapy and radiotherapy, antihypertensives such as calcium blocking drugs, anti-depressants and antipsychotic medications and certain antibiotics like nitrofurantoin in male infertility.
What are some of the highlights of being a fertility specialist?
Undoubtedly, one of the most important highlights of my practice is seeing a couple who have gone for years with infertility having, for the first time, a positive pregnancy test. The experience is priceless, and the second one is to meet them with a healthy baby in their arms. That is what keeps me looking forward to tomorrow in my practice, restoring hope where hope was gone, one baby at a time.
Please share topics you will touch at the ‘Just Sex’ event.
One of the key issues I will share include how fertility declines with age in the female, and the need for one to complete one’s family before the age of 35. I will also share, with those present, the global declining fertility potential in the male for, very truly, the male is in danger of becoming an endangered species.
Seemingly, a growing number of men are experiencing the early onset of erectile dysfunction…
Male erection largely depends on the function of the arteries in the penis and the nerve endings that penetrate and end in these arteries. In normal male erection the thought, sight, smell, taste or auditory stimulation of and by sex results in production of nitrous oxide by the nerve endings. The production of nitrous oxide leads to dilation of the small arteries leading to increase in blood flow in to the penis. It is this blood that is used to fill the blood sacs that were hitherto empty when the penis is flaccid. But, as these bags fill up, they compress the veins that drain them that are tucked between these sacs and the tunic found just beneath the skin. This leads to trapping of blood in the penile sacs and a firm penis ready for action. Anything that affects this mechanism would affect the ability of the penis to erect.
Blood pressure destroys the small arteries, making it difficult to achieve an erection. Too much cholesterol may be deposited on the walls of the penile arteries also affecting the ability of the arteries to respond to nitrous oxide. Diabetes affect the nerve endings and their ability to produce nitrous oxide required for the dilatation of the small arteries of the penis.
Other conditions such as multiple sclerosis and spinal cord injuries would affect the nerves from the spinal cord carrying erectile sensations for interpretation to the brain. Erectile dysfunction can be caused by certain medications such as antidepressants and antipsychotics. I need to also mention that testosterone deficiency is a very important cause of erectile dysfunction. In todays world, mention has to be made that as in females, stress is equally an important cause of erectile dysfunction .
What advice do you have for men this Movember?
Let this Movember be a turning point in the way we, as men, think and act about our health. Let it be a month of action. A month in which all men will go to their doctors to find out about their health.
For example, if you are a man aged 18 - 39, test for diabetes, cholesterol, kidneys and thyroid every 3 years. If you are 40 - 49, do these tests every 2 years and, for those 50 years and above, to test annually.
All men must test for blood pressure and do testicular examinations yearly. For men 40 years and above, must do a PSA test (a test for prostatic cancer) yearly from the age of 40 onwards. A fecal-occult blood test can be done yearly by all men 50 years and above. At the age of 50, men should do a colonoscopy and repeat it every 10 years, this is a reliable test for colon cancer. From the age of 40 onwards, men must do their eye exams every 2 - 4years, with all men doing dental examinations every 1 - 2 years. If men haven’t started doing this, let this Movember truly move you.
Last words..
Couples must know that infertility is a disease just like any other medical condition and that it is treatable. The earlier the couples present, the better. And lastly, and by all means not the least, I wish our men and our community to know that 50% of infertility is ascribed to the male and that males need to be investigated as early as infertility manifests in the couple.