Bottom Line: Want to have a baby and your partner is not getting pregnant? Then consider chilling out and find ways to reduce your stress level. It just may help those sperm reach the egg and get your family started. If you have questions regarding male infertility, see your urologist and get a semen analysis. It’s a test that every couple with an infertility problem should do.

Men and women can inherit and pass on a BRCA mutation. Men with a BRCA mutation have a lower chance overall of developing cancer than do women with a mutation, but their chances of breast cancer, prostate cancer, and a few other specific cancers are increased.
Men with a BRCA gene mutation have a higher risk of developing breast cancer, prostate cancer and skin cancer (melanoma). In some men (and women), BRCA2 gene mutations have been associated with an increased risk of lymphoma, melanoma, and cancers of the pancreas, gallbladder, bile duct, and stomach. Furthermore, these cancers are more likely to develop at a younger age in men with a BRCA mutation. Men with a BRCA mutation have a lower chance overall of developing cancer than do women with a mutation

Both men and women carry the BRCA gene mutation and it is possible for men to inherit the mutated gene from a man’s father.

Men from families with a history of breast and ovarian cancer in the women in the family should consider testing for a BRCA gene mutation particularly if any of the breast cancers occurred before age 50 (in either female or male relatives). Men with breast cancer themselves are highly likely to have a BRCA mutation and should consider testing. Men who have prostate cancer and a family history of breast cancer should also think about testing for the mutated gene.

Men who know they carry a BRCA gene mutation can take proactive steps such as getting screened regularly for some of the cancers associated with the mutation, such as annual prostate cancer screening with a PSA test and annual skin examinations for melanoma. Men with a BRCA mutation should also seek medical advice about any changes in their breasts such as breast tenderness, discharge from the nipple or a breast mass or lump. Even more so, it is important to share this result with your family when you deem appropriate, as it may be life saving information to your sisters, mother and daughters.

Bottom Line: BRCA gene is certainly an important issue for women but it is also important for men as well. If you have a family member with breast or ovarian cancer especially if they have the cancer detected before age 50, then they should have a test for the BRCA gene.

Dr. Neil Baum is physician and the author of What’s Going On Down There, The Complete Guide To Women’s Pelvic Heath and is available from Amazon.com

What’s Going On Down There-Improve Your Pelvic Health (amazon.com)

Guideline Statement 1: The Panel recommends against PSA screening in men under age 40 years. In this age group there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups.

Guideline Statement 2: The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk, i.e., those men who do not have a family member with prostate cancer or men of African American race. For men younger than age 55 years at higher risk (e.g. positive family history or African American race), decisions regarding prostate cancer screening should be individualized.

Guideline Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making between doctor and patient for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences. The greatest benefit of screening appears to be in men ages 55 to 69 years.

Guideline Statement 4: To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives. Additionally, intervals for rescreening can be individualized by a baseline PSA level.

Guideline Statement 5: The Panel does not recommend routine PSA screening in men over age 70 years or any man with less than a 10 to 15 year life expectancy.
Some men over age 70 years who are in excellent health may benefit from prostate cancer screening.

Bottom Line: I think not to screen men at all is probably not a good idea. However, in selected men, the decision not to screen is probably a good one. I do believe that men need to have a discussion with their doctors and decide on a case by case basis whether or not to screen for prostate cancer using the PSA test.

Blue balls are not just a figment of a male’s imagination or a lame excuse to try and get you in the sack. Though it doesn’t happen to all men, it is a very real condition that results from a prolonged state of sexual arousal. When a guy is physically turned on, blood flows to his penis, which is what gives him an erection, which is a good thing, and his testicles, causing them to swell, not such a good thing! If he doesn’t ejaculate, there is a buildup of pressure, and his supersensitive testicles start to hurt. The sensation can range from a mild ache to worse-than-getting-kicked-in-the-crotch pain.

Bottom line: Blue balls are not dangerous, and a young man can resolve it. The easiest solution is for the man to masturbate as an orgasm and ejaculation will cause the congestion in the penis and scrotum to abate. Just as the erection will subside after an ejaculation, the congestion around the testicles will also subside and the pain will go away. If the young man has an aversion to masturbation, then just waiting it out is also a solution as the blood will eventually drain, and any discomfort will disappear on its own.

Blue balls is a slang term referring to testicular aching that may occur when the blood that fills the vessels in a male’s genital area during sexual arousal is not dissipated by orgasm and ejaculation.

When a man becomes sexually excited, the arteries carrying blood to the genital area enlarge, while the veins carrying blood from the genital area are more constricted than in the non-aroused state.

The good news is that this uneven blood flow causes blood to be trapped in the two chambers of the penis resulting in the penis becoming erect. This increase of blood supply to the testicles and the trapping of blood around the testicles because the outflow of blood has been decreased causes vasocongestion or engorgement of the testicles resulting in an increase in size of the testicles by 25-50 percent. This distension of the testicles results in the pain and discomfort referred to as blue balls.

If the male reaches orgasm and ejaculates, the arteries and veins return to their normal size, the volume of blood in the genitals is reduced and the penis and testicles return to their usual size rather quickly.

If ejaculation does not occur there may be a lingering sensation of heaviness, aching, or discomfort in the testicles due to the continued vasocongestion.
The condition usually does not last long and the level of pain associated with blue balls is usually minor and can be exaggerated. Most men have been socialized to ejaculate when they get an erection during sexual activity. Failure to ejaculate and to feel orgasm often adds frustration and disappointment to the reality of the physical sensation.

Men who believe that they should ejaculate every time they have an erection are likely to exert pressure on their partner to proceed with sex without taking her feelings into consideration.
Some men find that masturbation is a viable solution and are realizing that ejaculation is not a requirement in every sexual situation. This attitude allows both men and their partners to relax more and to learn that pleasure and meaning can exist without having to reach ejaculation and orgasm during every sexual encounter.

It’s nice to know that men are not alone with this problem as it impacts both sexes. Both men and women experience the discomfort of unrelieved vasocongestion. Women’s genitals also become engorged with blood during sexual arousal and, like their male counterparts, women can experience pelvic heaviness and aching if they do not reach orgasm.

The value of the PSA test has recently come into question, however, with several studies suggesting it causes men more harm than good — spotting too many slow-growing tumors that, especially in older patients, may never lead to serious illness or death. In 2012, the U.S. Preventive Services Task Force, an influential government-appointed panel, advised against any routine use of the PSA test for prostate cancer in all men.

Since most urologists consider the Task Force’s guidelines and global ban on PSA testing far too stringent For that reason, a group of experts at the recent 2013 American Urologic Association’s annual meeting in San Diego recently recommended against annual testing and prostate biopsies at certain PSA levels, usually a level greater than 4.0ng\ml. It is possible that using the PSA test differently (for example, by testing less often) would still be useful but reduce the harms of unnecessary treatment such as urinary incontinence and erectile dysfunction that come from more frequent testing.

What are the new AUA recommendations? There are several ways of using the PSA test to help men make the diagnosis of prostate cancer while reducing the harms of testing. The first way is to stop screening after age 70 years because men older than 70 years tend to have higher PSA levels without having prostate cancer, or if they have cancer, it is usually the slow-growing variety and does not result in a cause of older men’s mortality. Another way to use the new guidelines included measuring PSA levels less frequently such as every two years in men whose levels are normal especially when the initial PSA levels are less than 1.0ng\ml. Finally, the doctor caring for older men might recommend that they have higher levels of PSA before recommending a biopsy and possible unnecessary treatment.

It is hoped that the new recommendations by the American Urologic Association will result in more personalized health management where discussions will take place between doctor and patient and where the risk of having prostate cancer and the age of the man are balanced against the value of screening.
The new AUA guidelines are more nuanced. The group does recommend against the PSA test for men under age 40 or for those aged 40 to 54 at average risk for prostate cancer.

The AUA says, however, that men aged 55 to 69 should talk to their doctors about the risks and benefits of PSA screening and make a decision based on their personal values and preferences.

Routine PSA screening is not recommended for men over age 70 or any man with less than a 10- to 15-year life expectancy.

The best evidence of benefit from PSA screening was among men aged 55 to 69 screened every two to four years. In this group, PSA testing was found to prevent one death a decade for every 1,000 men screened. The guidelines also said PSA screening could benefit men in other age groups who are at higher risk of prostate cancer due to factors such as race, i.e., African American men and men with family history of prostate cancer. These men should discuss their risk with a doctor and assess the benefits and potential harms of PSA testing.

Bottom Line: What do I recommend that you tell patients? I agree with the guidelines that men over age 70 probably do not need to be tested. Also men younger than age 50 do not need to be tested. The exception is African American men and men with a family history of prostate cancer. I would not test a man with multiple chronic conditions, which would decrease his life expectancy to less than 10 years. I would also suggest that men with very low PSA levels, i.e., less than 1.0ng\ml, be tested every two years.

Finally, the discussions between a patient and his doctor on the PSA test are extremely important. I suggest you ask the man if he gets a PSA test, would he submit to a prostate biopsy and if he has prostate cancer would he accept treatment for the condition? If the answer is no, then I would document this in the chart and not obtain the test.

A report from the May Clinic (2013;88:11-21) pointed out that men who lead a sedentary life style or who have low levels of physical activity are more likely to have an elevated PSA test. For each hour increase in physical exercise, men are nearly 20% less likely to have an elevated PSA test.

Regular physical activity may reduce prostate cancer risk through changes in energy balance, enhanced immune function, decrease in inflammation, and an increase in anti-oxidant defenses.

Bottom Line: No one knows what exactly causes prostate cancer but it is possible that an increase in physical activity may decrease the PSA level and possibly decrease the risk of prostate cancer.

Bottom Line: Want to improve your chance of having a baby? Get off of the couch and get moving!

This causes relationship distress and anxiety for the man but also impacts the partner as well. While some partners may enjoy the extended intercourse, especially if they experience premature ejaculation when the man was younger, it is common for the partner to blame themselves that they are no longer attractive or may even be suspicious that that the man is having another partner or an affair.

The causes of delayed ejaculation includes anything that disrupts the nervous system path to the genitals such as might occur with multiple sclerosis, spinal cord injury, diabetes mellitus, alcoholism. One of the most common causes is older men is a surgical procedure in the pelvis such as prostate gland surgery for prostate cancer, bladder cancer, or colon cancer. In these surgical procedures there can be injury to the nerves that supply the penis and result in decreased sensation of penis. There are numerous medications that can contribute to delayed ejaculation. Some of the culprits are medications for treating high blood pressure, antidepressants, antipsychotic drugs, some drugs used to treat enlarged prostate gland. Finally, aging results in decreased sensation to the penis and as a result more genital stimulation is required to achieve an orgasm.

The diagnosis is made with a careful sexual history. The doctor will ask about the man’s attractiveness of his partner, whether the man uses fantasy during intimacy, and also the masturbation patterns such as the frequency and technique of masturbation.

At the present time there is no FDA approved drug used to treat delayed ejaculation. Effective techniques include behavioral therapy such as temporarily suspend masturbation and by limit orgasm to sexual encounters. In men who have had previous pelvic surgery, increased sexual stimulation such as using vibrators, or erotic videos have often proved helpful. For most men with delayed ejaculation, treatment is usually successful.

Bottom Line: Delayed ejaculation is a common problem affecting millions of older men. The diagnosis is easily made and most men can be helped with behavioral therapy or with added genital stimulation.

Influence of Testosterone

Most men who have symptoms of low testosterone levels such as decreased libido (sex drive), erectile dysfunction, lethargy, and loss of muscle mass who used testosterone gel every day had their testosterone levels restored to normal and experienced benefits over time. These benefits included:
• Improvement in energy, sexual desire, sexual function, and mood within 1 month
• More muscle mass and decreased body fat within 3 months
• Increased bone strength within 6 months in patients receiving 10 grams of AndroGel daily
However, once you stop using testosterone gel, it is likely your testosterone levels will fall below normal in just 5 days and your symptoms may come back.

Your Goal with Treatment
Low testosterone is a medical condition that likely won’t go away on its own. There is typically no cure for low testosterone levels. The goal of treating low testosterone is to raise your blood level of testosterone and to keep the level in a normal range. Once your testosterone reaches a normal level and remains there, symptom relief may follow.