Very few men will admit to having issues down below – it’s just not something you talk about at the pub. But EX reporter Jade McLean wants to know all about your bits and pieces, so she put on a brave face for an in-depth chat with Dr Simon Chong and Dr Ong Chin Hu of Pacific Healthcare Specialists, about some of the weird and wonderful things that can happen as you get older.
According to Dr Chong, “erectile dysfunction (ED) happens to one in four men over the age of 40, but treatment is easily available and quite effective, even if the condition is severe.”
This is a very delicate matter for most men. What can you say to put their mind at ease about coming to see you?
Dr Chong: First of all, men need to understand that this is quite common. The type of treatment I can give depends on what a couple prefers and also the severity of the condition.
The partner also needs to understand the condition and not stress him out about it; rather, persuade him to talk about it and get a simple consultation.
How do you determine what the causes are?
The causes are often psychological and sometimes medical. More often than not it’s a combination of the two.
I try to find out the underlying causes by talking about his history. Psychological factors can be simple ones such as lethargy, stress at work or an unhappy relationship. All of these affect the sex drive and arousal as well. If a man masturbates and has no issues, but with his wife it’s not working, then it’s mostly psychological.
If it’s a combination, I would need to take a multi-pronged approach to treatment. For example, the patient could be a man with diabetes who has a relationship problem with his wife. After a period of time, this combination of factors may be causing ED. I often involve other practitioners under Pacific Healthcare, such as a psychologist or psychiatrist, to treat depression or anxiety.
The problem could be due to his partner as well – perhaps she’s post-menopausal or can’t relax enough for penetration, in which case I may also need to involve one of our gynaecologists.
Physically, what’s the problem?
For the erection pathway to happen there must be a stimulus to the brain. It could be something that’s physical or visual or some form of arousal that triggers the pelvic nerves, causing blood supply to the penis to increase and cause and erection. If this doesn’t happen, it can be due to the blood or nerve supply or due to a lack of testosterone.
Also if you have health issues, such as diabetes, a high cholesterol level or you’re obese, then these all tend to affect the heart and penile vessels and will affect your ability to get an erection.
What treatment can you offer?
There are three brands of tablet on the market at the moment – Viagra is the most well known – which help to improve blood flow to the penis. Also, it takes one hour for the tablets to work so it’s not spontaneous and the man will still need some stimulation.
What if the drugs don’t work?
We also have a relatively new treatment that we use concurrently alongside the tablets as it can make response to the tablets better. It’s called Shock Wave Therapy and has been around for five to six years. It works by increasing the number of blood vessels, blood supply and nerve supply to the penis. Research has found that a course of 12 sessions over nine weeks can still be effective after two years. If nothing at all is working, I would recommend surgery.
Can you really persuade men to put their penis under the knife?
Most men are really not enthusiastic about it, but the operation is not at all difficult and only requires one night in hospital. There are two types of penile prosthesis. One is made of silicon with metallic parts inside. It is a fixed length and malleable, a bit like one of those bendy table lamps. You tuck it in your pants for your day-to-day routine and straighten it out when you want to have intercourse. There is also an inflatable prosthesis available (the pump is placed inside the scrotum). These are also very good options for men suffering from premature ejaculation because they can still continue to have sex once they’ve ejaculated.
Research has shown that sex is important because it …
- is good for the heart
- is a good form of exercise
- allows better sleep
- prevents depression
- improves the immune system
- can lead to a longer life span
How do you know you have a kidney stone?
Dr Ong: Stones can form in your kidney over months or even years but you’ll be feeling just fine until the stone drops down into the channel (ureter) between the kidney and the bladder. This blockage causes pressure in the back near the kidney, resulting in the worst pain you can imagine. Patients usually present to the emergency department with acute symptoms.
What causes them?
There are many causes. It can be genetic or environmental – caused by your occupation, for example. If you work outdoors, it can be due to dehydration. If you’re well hydrated, your urine is less concentrated and the chance for a stone to crystallise is less likely. Certain food sources can also make you more prone, like chocolate, or certain types of nuts. I see stones in two categories: 25- to 40-year-olds who work outdoors and sweat a lot, and in men 50 and above, where stones have been forming over the years.
What are the treatment options?
If your symptoms are not too bad and the stone is quite small, you can wait for the stone to pass and take painkillers. Depending on the position of the stones, we can use shock wave therapy where a high-energy ultra sound wave is applied to the surface of the skin, breaking the stone down and allowing it to pass. Not all stones react though.
I can also use an endoscopy scope with a laser, which goes up through the urethra to the kidney and breaks it down. It’s more costly and has a good success rate but there’s slightly more risk as you’re under anaesthetic.
How often should a man be checked?
Dr Ong: This is the third most common cancer for men in Singapore, but screening is a bit controversial at the moment. My advice is if you have a family history of prostate cancer, it’s a good idea to get checked. There’s no strong advocate for general screening but if you want to, you should go if you’re over 40 years old.
What are the symptoms?
Unfortunately, you don’t have symptoms of prostate cancer until the disease is very advanced. Symptoms at this stage will often be the squeezing of the urinary tract due to an enlarged prostate, making it difficult to pass urine and making you need to go to the toilet often. It can also spread to bones causing bone pain and fractures in the later stages.
What’s the success rate of removal?
The success rate is high if you catch it before it spreads, or if the cancer isn’t very aggressive.