MYTH: IMPOTENCE IS USUALLY A PSYCHOLOGICAL, NOT A PHYSICAL PROBLEM.
Fact: If you think this is true, you’re certainly not alone. Many health professionals still believe “ifs all in your head.” We’ve talked with many patients who were told just that, despite a history of health problems that could easily account for the impotence.
Michael, for example, is a 70-year-old with a history of vascular problems. A complete examination and tests revealed that these blood-flow difficulties made it impossible for him to have an erection. After some discussion with his wife and physician, Michael decided to have a penile implant. (We discuss these in detail in chapter 8.)
Shortly before the surgery, Michael visited another physician on an unrelated matter. Upon hearing that Michael was having the operation, the doctor tried to discourage him. “If s unnecessary surgery,” he insisted. “The problem is in your mind.” Michael wisely ignored this inaccurate information. Since having the surgery he’s enjoyed a very satisfying sex life.
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Men’s Health
ERECTION PROBLEMS: THE IGNORANCE TRAP
Whatever the specific type of erection problem, it can make a man feel like an essential part of his identity is gone. He can become very depressed, critical of himself and insecure about his partner. Without a doubt, for many men erection difficulties can cause far more stress than other health problems.
And men often suffer that stress alone, since the whole subject of potency is taboo. Joseph, the divorced college professor, has friends who can talk about almost anything—but the subject of erections is still off limits. “After all, a guy who’s impotent doesn’t say, ‘Hi, just call me limpy,’” jokes Joseph.
Fred would certainly agree. A 39-year-old married man, Fred has never talked about sex or potency with male friends. “I don’t know men who really talk about sex. One summer I worked in a factory to make money for school, and the guys on the assembly line would brag about all the women they had. But it was just showing off.” Fred believes most men are not comfortable showing their vulnerability to another man. “Men are taught to be self-reliant, not to complain a lot. A lot of men think talking about problems is just complaining. And sex is one of the most difficult areas to talk about in any kind of meaningful way.” This reticence makes it difficult for a man to get accurate information.
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Men’s Health
POLYCYTHEMIA
Polycythemia means that the body produces too many red blood cells. Excessive amounts of red blood cells can cause you to feel weak and tired. You may experience headaches and develop high blood pressure because the blood becomes stickier than normal. There is an increased tendency for blood clots to form, and this can lead to thrombosis in any organ of the body.
Polycythemia is diagnosed by the finding of a very high hemoglobin on a blood count. In addition, the white blood cells and platelets may be increased. Sometimes special tests to verify that the body is making too much blood (red cell volume), are done to confirm the diagnosis.
Treatment usually consists of removing some of the excess blood (phlebotomy) every few weeks. This treatment must continue for life. Because of the increased blood volume, the increased blood pressure, and excessive stickiness of the blood there is a risk of strokes and damage to the heart and kidneys. If you have polycythemia, you should be treated periodically by your physician or hematologist experienced in dealing with this disease. Most older people with this disorder can be kept healthy for many years with treatment.
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Men’s Health
DIABETES MELLITUS
In diabetes mellitus the body’s blood sugar control becomes impaired. This disease is not the same as diabetes insipidus, an illness of the pituitary gland, in which excess urine is passed. Excess urine is also passed in diabetes mellitus, but the urine contains a large amount of sugar (glucose). (Diabetes insipidus is discussed at end of this chapter.)
The amount of glucose in your blood is determined by a number of factors. The different types of carbohydrates that are ingested are converted into glucose, a simple sugar that stimulates the pancreas to increase its output of the hormone insulin. Insulin helps the body metabolize carbohydrates, converting nutrients into glucose. The manner in which glucose and other nutrients are used by your body is also governed by the amount of insulin produced. The amount of glucose in your blood varies with the amount of food that you eat and the amount of exercise that you do.
If there is too little insulin, the level of glucose in your blood rises. If the glucose reaches a certain level, it begins to leak through the kidneys and “spills” into your urine. It is important to measure the amount of glucose in your urine with special testing kits that can be used at home.
As you grow older, your pancreas may become less able to produce enough insulin to fill your needs. If you are overweight, you may be putting an extra load on your pancreas. Even though there appears to be enough insulin, its effect is impaired because of the excess weight.
The most common type of diabetes mellitus in older individuals is called adult onset or non-insulin-dependent diabetes. This may affect you much more gradually than the kind that begins in younger people. Although it is not quite so dangerous, it must be treated carefully and controlled properly for you to maintain well-being and avoid complications.
Many people have latent diabetes mellitus. This means that your body has trouble controlling the blood glucose level, but this may not become obvious until you take certain medications or experience certain stressful illnesses. You will not develop diabetes mellitus because of the medications or illness, but you have a tendency toward it, and it manifests itself for the first time under these stressful circumstances, during a heart attack or pneumonia, for example. Diuretics and cortisone therapy may also cause latent diabetes to become evident.
Diabetics are in greater danger of developing infections, especially of the urinary tract. They also develop narrowing of the blood vessels as a result of atherosclerosis, which can result in an increased tendency to strokes, ischemic heart disease, peripheral vascular disease, kidney ailments, and eye disease. It appears that if care is taken to control the diabetes, the risk of these complications decreases.
Diabetics may develop ischemic heart disease without the usual symptoms of chest pain, and a heart attack (myocardial infarction) also may be experienced without chest pain and be revealed incidentally on a cardiogram long after the attack occurred.
If you are diabetic, you should take great care of your feet. Your nails should be cut properly (straight across) with the assistance of a physician, podiatrist, or chiropodist or by yourself after proper instruction if you feel secure and comfortable in the technique. Any foot infection or injury must be treated immediately to prevent progression and the possible risk of impaired blood supply and gangrene.
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Men’s Health
HOW IS THE CAUSE OF BACK PAIN DIAGNOSED?
If you have never suffered from back problems and suddenly develop back pain, you should have a physical examination to make sure that the nerves from your spinal cord have not been impinged upon by the vertebrae. Your doctor should check your reflexes and the strength and feeling in your legs and feet. He should check to see that your symptoms do not affect your bladder or bowel. Damage to nerves going to these organs can occur if the nerves are pressed upon by tumors or bony outgrowths from an arthritic spine. Difficulty with urination, constipation, or diarrhea are warning signs.
The next step should include a plain X-ray of your spine. If the diagnosis is elusive, sometimes a bone scan, a myelogram, and CAT or MRI scans, may be needed to determine whether there is excessive pressure on the nerves within the spinal canal.
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Men’s Health
IS DEAFNESS A NATURAL CONSEQUENCE OF AGING?
Many people develop some mild impairment of hearing as they grow older. Often it will not significantly interfere with your function, although in some instances it can be disabling. If you suffered from an injury to your eardrums many years ago and it was not properly treated, a decrease in hearing may persist and become worse with time. This might respond to surgical repair. Wax in the ears alone does not usually cause a significant decrease in hearing. However, if your ear canals are completely blocked by wax, you may experience some decrease in your hearing in addition to a feeling of fullness or pressure in the ear. In this case a hearing aid may not work properly until the wax is removed.
One cause of decreased hearing is otosclerosis. Even though it is more common in younger people, it can progress throughout life. In this condition the small bones in the ear that help transmit sound become rigid and no longer vibrate properly, so the sound waves do not pass the middle ear to the inner ear.
There is some controversy as to whether older people might benefit from surgery to make the bones mobile again. There is good evidence that in some older individuals, this type of surgery may be very successful. In some instances the surgery alone restores hearing. In others surgery can improve the results of using a hearing aid, which may be needed after the operation.
A very common cause of hearing loss is the deterioration of the inner ear (nerve deafness). The exact cause is unknown, but it affects most older people to some degree. Some people seem to be able to hear with no problem until they are very old, whereas others begin to lose their hearing earlier. Although no special treatment will return hearing if you have this problem, some improvements can be made. In some instances a hearing aid may be of value, although it is less often helpful in this kind of deafness.
Aspirin, often prescribed for arthritic conditions, can interfere with hearing and may cause ringing of your ears. This improves when the aspirin is stopped or the dosage reduced. Some strong antibiotics used in serious infections may also interfere with hearing and with balance.
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Men’s Health
PARKINSON’S DISEASE
Parkinson’s disease is more common in the elderly, but its cause is not known. Because the degree of symptoms vary, some people may be completely incapacitated by the illness, whereas others may not even realize that they have it. The most prominent symptoms are slowness in walking, shaking and stiffness of the limbs, and difficulty in speaking and swallowing. Your facial muscles may droop and friends or family may wonder why you always appear “unhappy.” You may develop a “shuffling gait,” which means that you do not lift your legs from the floor when you walk and often you have difficulty in turning. This often causes falls. The difficulty you experience in walking and getting out of a chair or bed may be attributed to arthritis or “just growing old.” Often, because the symptoms are mild, a diagnosis may be overlooked. Tranquilizers or drugs for the treatment of a hiatus hernia (metoclopramide) can cause a drug-induced type of Parkinson’s disease.
Even though some people with severe Parkinson’s disease have difficulty speaking, their memory and judgment are usually quite good. There is some suggestion that after the disease has been progressing for many years some loss of mental function may occur, but this may not be as severe as in other diseases of the brain. Unfortunately, many people assume that because a person cannot move or speak quickly the mind is also impaired, and this can be very frustrating and aggravating.
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Men’s Health
GYNECOLOGICAL TUMORS
The most common gynecological tumors are found in the cervix (the part of the uterus that projects into the vagina), but growths in the uterus are also common. There has been some controversy about the factors that contribute to the high incidence of such tumors. It appears that numerous pregnancies and numerous sexual partners may make women more prone to cervical cancer.
Cancer of the uterus appears to be somewhat more common in women who take female hormone (estrogen) medications after menopause, even though there are many positive aspects to the use of these medications. The data are conflicting, but it seems that the use of estrogen medications alone slightly increases the chances of developing uterine cancer. If a small amount of progesterone is added to the estrogen, the risk seems to decrease a great deal. Controversy continues as to whether women should take these medications. Medical opinion has been shifting steadily toward recommending the use of combination estrogen and progesterone after menopause to decrease the risk of osteoporosis (weak bones).
Having a Pap test of the cervix every one or two years is an important way to decrease the chance of developing cancer of the cervix or uterus. The Pap smear can indicate the disease in the early stages, when treatment is simpler. If a malignancy is found, local surgical removal of a small part of the cervix or the use of radiation, and recently the use of locally applied chemotherapeutic agents, may be of value. In more advanced stages removal of the whole uterus (hysterectomy) may be required. The results are usually good, especially if the disease is found early. Even in advanced cases some improvement in symptoms and relief of discomfort can result from a combination of chemotherapy and radiation therapy.
Cancer of the uterus may first show itself with bleeding after menopause, an important symptom that should never be overlooked. If you have been taking estrogen hormones alone for menopausal symptoms, bleeding during therapy or between cycles of drugs should not occur. Sometimes if progesterone is added to the estrogen, there may be some bleeding between drug cycles. However, if you have never experienced bleeding with these medications you should see a physician if bleeding develops at a later date. Do not assume that the symptom, especially if it occurs in the midst of a cycle, is due to hormone therapy. Bleeding of any type should always be reported to your physician.
The ovaries can also be affected by cancer, and growths are sometimes found during routine gynecological examinations. For this reason, it is important to have a pelvic examination every year or two even after you have stopped menstruating. The first symptom may be a feeling of fullness in the lower part of the abdomen.
Treatment includes surgery to remove the tumor, and some women require radiation therapy and chemotherapy. The response to treatment can be good. Although the tumor may return, a further course of treatment can be initiated.
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Men’s Health
OTHER GYNECOLOGICAL PROBLEMS
Vaginal Itching and Pain
Vaginal itching can be very embarrassing. Many women with this problem avoid consulting a physician. A number of infections cause vaginal itching. A common one is the result of a yeast called Candida albicans. This may be the first sign of diabetes mellitus. Infections of the urinary tract may also cause local irritation, but this is more common if you have some urinary incontinence. Senile vaginitis may cause itching and pain in addition to bleeding, but it usually is prevented by cyclical hormone therapy or treated by local application of estrogen cream. Other skin problems in the vaginal area can easily be diagnosed and treated.
Vaginal Prolapse
A prolapse is a weakening of the vaginal wall that causes the bladder to sag into a vagina. The most common symptoms are a fullness or heaviness in the vaginal area and a leakage of urine when coughing or straining. There may be an increased susceptibility to urinary tract infections. Sometimes part of the intestine may protrude into the vagina and also cause problems with bowel movements.
In many instances surgical repair of a prolapse is the most effective treatment to relieve your symptoms completely. A pessary (a doughnut shaped device that is placed in the vagina) may be successful, although surgical repair is preferable for most people.
Malignant tumors of the cervix, uterus, and ovaries can occur at any age. The symptoms may be vaginal bleeding or weight loss and abdominal swelling.
Treatment is usually directed by a gynecologist and oncologist (cancer specialist). This may include surgery, radiation, and chemotherapy, or a combination of any of these treatments. Many women respond very well to such treatment. If your physician believes that this therapy may succeed, it should not be refused because of your age.
Vaginal Odor
Some women notice an offensive odor in their vaginal area. Odor can be associated with a vaginal discharge, but the most common causes are various infections, such as that of the yeast Candida albicans, often associated with diabetes mellitus. Perspiration due to poor hygiene and obesity may exaggerate the odor.
Occasionally a tumor in the vulva, vagina, cervix, or uterus produces a foul-smelling discharge which may contain blood. Such a discharge is not normal, and you should consult your physician about it immediately.
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Men’s Health
GENITOURINARY AND GYNECOLOGICAL DISORDERS
The genitourinary system consists of the kidneys, ureters, bladder, and urethra, as well as the organs of reproduction. From the kidneys to the bladder, the urinary systems are exactly the same in men and women. In women the urethra has only a short distance to travel before it reaches the surface, just above the entrance to the vagina. Women’s organs of reproduction are close to the bladder and urethra. Because of this, abnormalities of the urinary system can affect the organs of reproduction and vice versa.
In men the urethra passes through the prostate gland and the penis before it exits from the body. Because the distance along which the urethra must pass is longer, the possibility of urological disorders is greater.
For most problems occurring in the male genitourinary system a urologist is consulted. Women would consult a gynecologist for genitourinary problems.
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Men’s Health
