Male Health

  1. Erectile Dysfunction

Erectile Dysfunction

What is ED and how common is it?

Erectile Dysfunction (ED), also sometimes known as impotence, is the persistent or recurrent inability to achieve and/or maintain erection sufficient for satisfactory sexual intercourse. This happens when not enough blood can get into, or stay in the penis long enough to allow an erection.

Many men live with ED for years without seeking medical advice, because of embarrassment or a belief that ED cannot be treated. However, in most cases ED treatment is straightforward and effective. In addition, ED may be an early warning sign of other conditions. So it makes sense not to allow embarrassment to get in your way -if you are worried about ED, go to your doctor without delay to get it checked and treated. 

What causes ED

In many cases, ED is caused by a combination of both physical and psychological factors. A proper medical assessment is important as ED could be caused by an underlying illness, medication side effects, or be related to psychological issues - see some common causes below:

  • Diabetes
  • Heart Disease
  • High blood pressure
  • Nerve conduction problems e.g. multiple sclerosis and Parkinson’s disease
  • Following prostate surgery
  • Medication side effects:
    Some medicines used to treat conditions such as high blood pressure or depression may have ED as a side effect.
  • Stress
  • Excess alcohol
  • Smoking

The earlier a health problem is attended to, generally the easier it is to treat. So if you are worried that you may have ED, go to your doctor without delay.

Welcome to the 2nd step towards dealing with ED,
Get Checked

Your doctor will ask you questions about your general health and how ED is affecting you physically and psychologically. Up to 80% of ED is caused by an underlying physical condition, so your doctor may want to carry out some checks, such as:

  • Your GP may want to review the medicines you are currently taking.
    ED may be caused by the side effects of some medications so your doctor will want to ensure that your ED is not due to this.
  • Your GP may check your blood pressure.
    High blood pressure is linked to heart disease and diabetes, both of which are known to be causes of ED.
  • Your GP may take a blood or urine test to check sugar levels.
    If your sugar levels are raised, you may need additional tests to check for diabetes.
  • Your GP may take a blood test to check your cholesterol levels.
    ED may be due to problems with your blood vessels (sometimes known as “hardening of the arteries”). Because raised cholesterol can make this problem worse, your doctor may check your blood cholesterol level and if it is too high advise you on how to bring it down.
  • Your GP may perform a blood test to check the testosterone levels in your body.
    Low levels of this hormone could affect your sex drive and general health.

What can be done?

There is now a range of treatments available for Erectile Dysfunction, so there’s no need to worry. Your doctor is the best person to talk to about Erectile Dysfunction.


What is Testicular Cancer?

Testicular Cancer is a growth or tumour, which appears in one of the testicles (which are commonly known as ‘balls’). The testicles are the male reproductive organs contained within a bag of skin called the scrotum, which hangs below the penis. The testicles produce sperm.

What causes Testicular Cancer?

The causes of Testicular Cancer are not known but men born with undescended or partly descended testicles are more likely to develop Testicular Cancer. Research has shown that the risk is increased if you have a family member, father or brother who has developed the disease. Testicular Cancer is one of the most common cancers in young men aged between 15 and 34 years. Approximately one in 280 Irish men will develop Testicular Cancer. Testicular Cancer can be cured if detected at an early stage.

What to look out for?

A swelling or lump in one of your testicles which is not usually painful is the most common sign, however there are other signs to look out for:

• Small lumps or hardness

• Swelling, tenderness

• A sensation of dragging or heaviness in the scrotum

• A dull ache in the lower abdomen or groin

It is important to note that most lumps are benign (noncancerous) but others may be cancerous and should be treated immediately.

How should I check myself ?

Hold your scrotum in both hands and use your fingers and a thumb to examine your testicles. It is common for one testicle to be slightly larger than the other, so don’t be alarmed if this is the case. Gently feel each testicle, one at a time. You should be able to feel a soft tube at the top and back of both of them. This tube (epididymis) carries the sperm. It may be slightly tender but do not confuse this with an abnormal lump in the testicles. Often the best place to do this is in the bath or shower where the scrotum is relaxed and the testicles can be felt easily.

What to do

Any man who notices any of the above signs should seek his General Practitioner’s advice immediately. The General Practitioner will be able to assess you and if necessary, refer you to a consultant for further investigation. Do not be embarrassed or nervous, remember early detection of the disease is your best chance of a cure.

What is the treatment for Testicular Cancer?

Initial diagnosis is made by an ultrasound scan of the testicle and by blood tests. If these are very suspicious then the abnormal testicle is removed by surgery with a small incision in the groin. The patient is then scanned to see if the cancer has spread. Depending on the scans and the results of tests on the abnormal testicle, the patient may be advised to have adiotherapy or chemotherapy to destroy any remaining cancer cells and prevent the cancer returning. The results of modern treatment for Testicular Cancer are excellent even in those patients where the cancer has spread outside the testicle to other parts of the body.

Sexual function and fertility

Many patients are concerned that losing a testicle will affect their sex drive and fertility. They should not worry. Removing one testicle does not affect sex drive or the ability to have an erection provided the remaining testicle is normal. The loss of a testicle may embarrass a young man and make him feel insecure in sexual situations. For this reason a testicular prosthesis (false testicle) can be placed in the scrotum at the time of surgery to remove the cancerous one. Fertility can be compromised by Testicular Cancer treatment. However the potential to father children should not be greatly affected by removing one testicle provided the other is normal. Indeed most cancerous testicles have little sperm production capability by the time of diagnosis. Chemotherapy, however, does affect sperm productions in the other “good” testicle. Most testicles will recover after 2 years but in some, sperm production may remain reduced. Because of this, it is now recommended that patients with Testicular Cancer arrange to “freeze sperm” so that if there are problems with fertility later on, this frozen sperm can be used to fertilize a partner’s egg and father a child. This facility is available in the RotundaHospitalfor all cancer patients.


What is the prostate?

The prostate is a small gland found only in men and is part of the male reproductive system. It is the size of a walnut and surrounds the first part of the tube (urethra) which carries urine from the bladder to the penis. The prostate lies close to the rectum (back passage) through which it can be closely felt and examined for its size. The function of the prostate is to make some of the fluid used to carry sperm.

What causes prostate cancer?

The cause of the majority of prostate cancers is unknown.  However, the risk of developing prostate cancer may be slightly increased with the following

• Increasing age

• Family history

• Diet

• Race

How common is prostate cancer?

Prostate is the most common male cancer. There is some evidence to suggest that the”Western diet” which is rich in fats and low in fibre, plays a role. If a close male relative develops prostate cancer the risk of developing the disease may be

slightly increased. African-Caribbean and African-American men are more at risk than other ethnic groups. Prostate cancer responds well to treatment and if detected early it can be treated successfully.Cancer

What to look for

Early prostate cancer is often present without any obvious symptoms. However, if you have any of the symptoms listed below do make an appointment with your doctor.  Urgency, is it difficult to postpone or put off passing urine, feeling the need to rush to the toilet to pass urine Frequency going to the toilet more frequently than before, Nocturia, needing to get up more than twice at night to pass urine Hesitancy taking time to get going when trying to pass urine Flow has the flow of urine become weak or intermittent, starting and stopping Incomplete emptying, feeling that the bladder has not emptied properly after passing urine Blood, is there blood in the urine?

It is important to note that the prostate enlarges with age, it wraps around the urethra and this enlargement (Benign Prostatic Hyperplasia- PBH) can cause bladder outlet obstruction which can lead to the above symptoms. BPH is more common than prostate cancer but the conditions may exist together. BPH is not cancerous but can be troublesome.

What to do

If you experience any of the above symptoms do please make an appointment with your GP. He or she will determine the severity of your symptoms and examine your prostate gland. Examination involves a digital rectal examination (DRE) where the prostate is examined and felt by the doctor by using a finger in the back passage. The examination itself will be painless and quick and will assesses the size, texture and consistency of the gland and look for any irregularities.

How is prostate cancer diagnosed?

Tests and investigations to diagnose prostate cancer include digital rectal examination, blood tests (PSA) a rectal scan (transrectal ultrasound) and a biopsy of the prostate.

What is the PSA blood test?

PSA is prostate specific antigen, this is a substance produced by the prostate but in higher quantities in men with prostate cancer. Other causes of a raised PSA blood test include benign prostatic hyperplasia in men with a large prostate gland and infection or inflammation in the prostate (prostatits). A raised PSA blood test does not mean that you have prostate cancer but that you may have an increased risk of developing the disease. If the PSA is raised, your doctor will talk to you about your options. Men in Irelandare not routinely offered PSA tests to screen for prostate cancer. There are many reasons for this the most relevant being that for a screening tool to be effective it has to be reliable and unfortunately although the PSA is prostate specific it is not cancer specific. In other words the PSA can be raised for reasons other than cancer.

What is the treatment for prostate cancer?

Prostate cancer treatment will depend on

• The stage and aggressiveness of the tumour at the time of diagnosis

• The age of the patient

• General health of the patient

Some of the treatment options include, watchful waiting, surgery, radiotherapy (external beam or brachytherapy), hormone therapy, chemotherapy, cryotherapy and high intensity focused ultrasound.  Your doctor will discuss your treatment options with you, it is often useful to have a friend or relative with you when the treatment is explained. Some patients find it helps to write down a list of questions before going to the appointment.

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