Archive for April, 2010

Treatment of the Enlarged Prostate Gland With Laser Therapy

April 25, 2010

The prostate gland is a walnut sized organ below the bladder, which surrounds the urethra.  For reasons not completely understood, the prostate gland begins to grow around age 50 and causes symptoms affecting urination.  The enlarged prostate gland is a non-cancerous condition that affects nearly 14 million men over age 50.

The symptoms of the enlarged prostate include frequency of urination, getting up at night to urinate, urgency to urinate, decrease in the force and caliber of the urine stream and feeling that the bladder is not emptying.

The treatment for enlarged prostate includes medication to shrink the prostate gland or to relax the muscles in the prostate to relieve the obstruction.  Surgical therapy includes transurethral resection of the prostate (TURP) or open surgery for very large prostate glands. Recently laser therapy has become available for treating the enlarged prostate gland and is considered minimally invasive therapy.

Laser therapy is a procedure performed with a small fiber that is inserted into the urethra, the tube in the penis that allows urine to go from the bladder to the outside of the body.  The fiber delivers high-powered laser energy, which quickly heats the prostate tissue, which causes the tissue to dissolve or vaporize.  This process is continued until all of the enlarged prostate tissue has been removed. The end result is a wide-open channel for urine to pass through the urethra.

Laser therapy can be performed in a hospital outpatient center or an ambulatory treatment center.  Usually no overnight stay is required.  However, in some cases when a patient comes from a great distance, has associated medical problems such as heart disease, diabetes, or severe hypertension, or is in frail condition, an overnight stay may be recommended.

After the procedure

Most men will go home within a few hours after treatment. If a tube or catheter was inserted after the procedure, it will usually be removed the next day after the procedure.

Most patients experience marked improvement in their urinary symptoms immediately after the procedure.  This improvement typically occurs within the first 24 hours after the procedure.  However, the past medical history, health condition and other factors can influence treatment recovery.

Some men may experience mild discomfort such as slight burring during urination and small amounts of blood in the urine for a week or two.  Also, depending upon the condition of a man’s bladder, he may experience greater frequency and urge to urinate.  This will resolve over time as the bladder adjusts now that the obstruction has been removed.

There is no change in a man’s sexual function after the procedure.  His ability to engage in sexual intimacy after the procedure is unchanged.  Most men can begin sexual activity two weeks after the procedure.  Approximately 25% of men will have a decreased or absence of ejaculation at the time of orgasm.  The fluid is still there but goes backwards into the bladder and passes in the urine the next time the man urinates.

What are the risks of the laser procedure?

Every medical treatment may have side effects.  The same is true for the laser treatment.  The most common side effects include:  blood in the urine, bladder spasms, and urgency of urination.  These symptoms are usually temporary and will subside in a few days or weeks.

Bottom Line: Enlarged prostate gland is a common condition that affects most men after age 50.  Treatment options include medications, surgery and minimally invasive treatment using lasers.  The laser treatment produces a rapid improvement in urine flow, a quick return to normal activities, short or no hospitalization.

Tips and Tricks for Smoking Cessation

April 23, 2010

I have never met anyone who has smoked for several years who declares that they enjoy smoking or that they could quit anytime they wanted. Nothing could be farther from the truth. Studies have shown that nicotine addiction is as hard to break as heroin or cocaine addiction. This article will focus on tips and techniques to help smokers kick the habit. After reading this article and if you are a smoker, you will have suggestions to help get the nicotine monkey off your back.

There are two phases to successful smoking cessation:

  • Phase one is getting help and assistance.
  • Phase two is staying smoke-free and not relapsing as so many quitters have done in the past.

Phase One-Getting Help

The most successful quitters are those who get help and plenty of it. Sadly, eighty percent of smokers who quit do so without being in any program. Many studies have shown that 95% of these self-reliant quitters fail, and go right back to smoking a short time later.

That’s the bad news. The good news is that most smokers can successfully kick the habit if they recognize that they can’t do it alone. Your past failures are not a lesson that you are unable to quit. Instead, they are part of the normal journey toward becoming a nonsmoker.

Successful quitters buy a “How to Quit Smoking Book”, or a motivational cassette tape program in a bookstore, and listen to the tapes in your car. Next, there are help groups in most communities including New Orleans. The American Cancer Society, or the American Lung or Heart Associations have inexpensive and effective, smoking cessation programs. The National Cancer Institute’s Smoking Quitline, 1-877-44U-Quit, offers counseling by trained personnel.

Other top of the line, physician-endorsed methods include nicotine replacement and Zyban. The nicotine patch or gum are now available at any pharmacy without a doctor’s prescription. The anti-depressant Zyban and nicotine inhaler do require a doctor’s prescription.

Recently the FDA approved a new medication, Chantix, which was designed to inhibit a part of the brain that is responsible for the addiction to nicotine. As a result the medication reduces a smoker’s nicotine addiction, as well as decreasing the craving for cigarettes and diminishes the withdrawal symptoms for those who decide to go cold turkey.

Chantix is given twice a day for 12 weeks and then an additional course of 12 weeks of medication is recommended to increase the likelihood of long-term abstinence and to reduce the urge to smoke.

Phase two-staying smoke free and not relapsing

Those who have successfully kicked the habit will report that overwhelming surprise attacks of a desire for cigarettes are sure to come a few weeks or months into your new smoke free life. You can anticipate irresistible urges that may take you by surprise and try to encourage you to have “just one”. Even months after you have been smoke-free, the experts say that you can count on these cravings occurring.

When these nearly out-of-control urges come, one of the best ways to make them pass is to take a few deep breaths. Perhaps the single most powerful and important techniques is taking a few deep breaths when that uncontrollable urge arrives. Every time you want a cigarette, do the following:

Inhale the deepest lung-full of air you can, and then, very slowly, exhale. Purse your lips so that the air must come out gradually.

As you exhale, close your eyes, and let your chin gradually sink over onto your chest. Visualize all the tension leaving your body, slowly draining out of your fingers and toes, just flowing on out.

This is a variation of an ancient yoga technique from India, and is very centering and relaxing. If you practice this, you’ll be able to use it for any stressful situation you find yourself in. And it will be your greatest weapon during the strong cravings sure to assault you over the first few days when you stop smoking.

Another important technique you can use to avoid relapsing is self-talk. Several times a day, quietly repeat to yourself the affirmation, “I am a nonsmoker.” Many quitters see themselves as smokers who are just not smoking for the moment. They have a self-image as smokers who still want a cigarette. Silently repeating the affirmation “I am a nonsmoker” will help you change your view of yourself, and, even if it may seem silly to you, this is actually useful and very effective.

Self-talk is a reminder to yourself that if you can hold out for just five minutes the overpowering urge to smoke will completely pass.

Bottom Line: No one needs to be told that smoking is unhealthy. Nearly everyone who smokes would like to quit. However, the addiction to nicotine is often more than most of us can handle without assistance. If you use the two- phase technique I have recommended, you can plan to become and remain smoke-free. Remember, when treating tobacco dependency, every step towards quitting is one step closer to success.

A Kegel A Day Keeps the Doctor Away

April 22, 2010

Mary Ann is a 45-year old woman who loses urine (incontinence) when she coughs and sneezes.  She is provided with exercises to strengthen the pelvic floor muscles of her bladder. She does the exercises every day for 12 weeks and has significant improvement in her urinary symptoms.

There are many conditions that put stress on your pelvic floor muscles such as childbirth through vaginal deliveries, obesity, chronic coughing, and after menopause when there is a deficiency of estrogen or the female hormone produced in the ovaries.

When your pelvic floor muscles weaken, your pelvic organs descend and bulge into your vagina, a condition known as pelvic organ prolapse. The effects of pelvic organ prolapse range from uncomfortable pelvic pressure to leakage of urine or feces. Fortunately, Kegel exercises can strengthen pelvic muscles and delay or maybe even prevent pelvic organ prolapse.

How to perform Kegel exercises

It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. You can learn to identify the proper pelvic muscles by trying to stop the flow of urine while you’re going to the bathroom.

If you’re having trouble finding the right muscles, don’t be embarrassed to ask for help. Your doctor can give you important feedback so that you learn to isolate and exercise the correct muscles.

After you’ve identified your pelvic floor muscles contract your pelvic floor muscles and hold the contraction for three seconds then relax for three seconds.  Repeat this exercise 10 times.  After you have learned how to contract the pelvic muscles for 3 seconds, work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.  Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as sitting at a red light.

For those women who have trouble doing Kegel exercises, biofeedback training or electrical stimulation may help. In a biofeedback session, a nurse, therapist or technician will either insert a small monitoring probe into your vagina or place adhesive electrodes on the skin outside your vagina or rectal area. When you contract your pelvic floor muscles, you’ll see a measurement on a monitor that lets you know whether you’ve successfully contracted the right muscles. You’ll also be able to see how long you hold the contraction.

Results are not immediate or the first time you do the exercises.  You can expect to see some results, such as less frequent urine leakage, within about eight to 12 weeks. Your improvement may be dramatic — or, at the very least, you may keep your problems from worsening. As with other forms of physical activity, you need to make Kegel exercises a lifelong practice to reap lifelong rewards.

An added bonus: Kegel exercises may be helpful for women who have persistent problems reaching orgasm.

Bottom Line:  Many women have a problem of loss of urine with coughing and sneezing.  Kegel exercises are effective for very mild urinary incontinence.  It’s inexpensive, does not require use of medication, and if you are patient, it does, indeed, work.

Low Sexual Desire-When It Isn’t All You Want It To Be

April 22, 2010

Has your desire for sex and sexual intimacy gone into the tank?  Are you having fewer thoughts about engaging in sexual intimacy with your partner?  If so, you may be suffering hypoactive sexual dysfunction.  You might take comfort in knowing that this is a common problem that affects both men (35%) and women (45%).  That’s the bad news.  It is a problem that most who suffer from decreased sexual desire will not share with their partner or with their doctor.  The good news is that help is on the way and many who suffer from this common problem can be helped.  In this article I will discuss the causes of decreased sexual desire and what treatment options are available.

Causes of low sexual desire

Low sex desire is a very common sexual disorder.  It occurs when one partner does not feel intimate or close to the other.  Often the problem is result of a diminished affection for the other partner, power struggles between the two partners and not having enough time to be alone in order to be intimate.  Low desire can also be a result of a strict or religious background where sexual intimacy is often associated with scorn and negativity.  The problem can also occur when there is a history of sexual trauma at an earlier age or sexual abuse by a parent or relative.  Lack of desire is also associated with medical conditions such as heart disease, diabetes, kidney disease, thyroid deficiency, and arthritis.  Drug abuse and excessive alcohol consumption are culprits in causing decreased sexual desire.  There are literally hundreds of medications that are associated with the side effect of inhibited sexual desire.  These include anti-depressants, Paxil, Zoloft, and Prozac.  Hormone deficiency is another common culprit such as a decreased testosterone in men and decreased estrogen in women as is so common following menopause or surgical removal of the ovaries.  In addition to these physical causes of decreased sexual desire, there are psychological conditions such as depression, stress, fatigues, lack of sleep, and lifestyle problems such as career changes and martial discord that can be a primary cause or can contribute to the problem.  Finally, there is a problem referred to as fear of failure that impacts both men and women.  If a man has impotence, premature ejaculation, restarted ejaculation or a women has painful intercourse or does achieve an orgasm can lose interest because they don’t want to experience repeated failure and embarrassment in the bedroom.

Treatment of decreased sexual desire

If the problem is due to estrogen deficiency, then your doctor can simply order estrogen replacement therapy which includes either oral medication or topical vaginal creams or suppositories that can restore the vaginal lining to a normal state.

If the problem of decreased libido is a side effect of medication, your doctor can reduce the dosage of your existing medication or change to another class of medication that is not associated with diminishing sexual desire.

Wellbutrin has been reported to improve symptoms of low sexual desire in women.  The reports are that nearly a third of the women will experience a doubling of their interest in sexual activity after using Wellbutrin.  Although Wellbutrin is an anti-depressant, the drug was shown to be effective in women without depression and only complaining of decreased sexual desire.

Psychotherapy has also been shown to be helpful in managing low sexual desire.  For women who are in a stable relationship, the therapist explores problems with communication between the partners or provide advice and education to enhance sexual stimulation by the woman’s partner.

On the horizon is a new drug that may just be the female equivalent of Viagra.  The drug is specially used for treating decreased sexual desire.  If you are interested in participating in research study involving this new medication, call 504 891-8454 to see if you qualify to participate in the study.

When to call the doctor?

If you are not satisfied with your current level of sexual desire and intimacy and you find that the remedies suggested in the tabloids and other self-help publications are not effective, you should consider consulting with your doctor so that they might identify physical and\or psychological causes that are treatable.

Bottom Line:  Decreased sexual desire is a common condition in both men and women.  Fortunately, most of those who suffer from decreased sexual desire can be helped.  If you are one of these men or women, share this article with your partner and make an appointment to see your doctor.

10 Steps to Prevent Impotence

April 22, 2010

Sexual Problems in Men-Is it low libido or impotence

April 14, 2010

Nearly 30 million men suffer from erectile dysfunction (ED) or impotence and nearly half that number have a decrease in their sex drive or libido.  However, many men believe that erectile dysfunction and diminished libido are the same thing.  It is important that men understand the difference between ED and libido.  ED is the inability to achieve and maintain an erection adequate for sexual intimacy with a partner.  Loss of libido is a decrease in the interest for sexual intimacy.  ED and loss of libido can be separate issues or can occur together as it is common for a man who suffers from ED for a prolonged period of time will also experience a decrease in libido.

What are the symptoms of decrease in libido and what are the causes of this condition?   A decrease in libido is usually a result of a decrease in the level of testosterone which is a hormone produced in a man’s testicles.  A decrease in libido is the most common symptom of testosterone deficiency.  Men with a decrease in testosterone also experience a lack of energy and often complain of lethargy.  Men with decrease in testosterone also experience a decrease in strength or endurance, lose height, fall asleep after dinner, and may even experience depression or a decreased enjoyment in life.

Some causes of testosterone deficiency include:

Testes – medical problems that begin in the testes can prevent sufficient testosterone production. Some of these conditions are present from birth; for example Klinefelter’s syndrome, a genetic disorder that affects the sex chromosomes. Other conditions may occur at various stages of a boy or a man’s life; for example, undescended testicles, loss of testes due to trauma or ‘twisting off’ of the blood supply (torsion), complications following mumps, and the side effects of chemotherapy or radiotherapy.

Pituitary gland – the most common condition that affects the pituitary and leads to low testosterone levels is the presence of a benign tumour. The tumour may interfere with the function of the gland, or it may produce a hormone that stops the production of the gonadotrophins and stops the pituitary gland from signalling the testicles to produce testosterone.

Hypothalamus – particular conditions, such as tumours or congenital abnormalities, can prevent the hypothalamus from prompting the pituitary gland to release hormones. This will inhibit testosterone production by the testicles. This is a rare cause of androgen deficiency.

Drugs can also decrease libido. Many prescription antidepressants can diminish sex drive. Other medications with this side effect include tranquilizers and blood pressure medications. Illicit substances, such as heroin, cocaine, and marijuana, when used heavily and chronically, may lower libido and sexual performance.

Testosterone levels gradually decline after the age of 40. Some estimates suggest that up to one in five men over 70 years have low testosterone levels. A number of factors may contribute to the fall in testosterone, in addition to the ageing process itself. For example, any cause of poor general health, including obesity, will lower testosterone.

The diagnosis of low testosterone is made by a careful history and physical examination followed by a blood test that measures the testosterone level in the blood.

Treatment for proven androgen deficiency is based on hormone (testosterone) replacementtherapy. Testosterone can be administered by tablet, skin patch or gel, injection (short or long acting) or implant.  There is a long acting implant that consists of a pellet that is placed underneath the skin using a local anesthetic in the doctor’s office.  The pellet usually lasts for approximately 6 months and can be easily replaced using the same technique. Men who receive testosterone replacement therapy will require regular visits with their doctor. Prostate examinations are performed according to a man’s age and other risk factors for prostate cancer.

The benefits of testosterone replacement therapy include Increased sexual interest, restoration of erectile function, increased muscle mass, increased strength of bones, and improved mood and sense of well being.

Most sufferers of Low testosterone believe their symptoms are simply a function of growing older. As a consequence, they never seek the medical attention needed. Today, low testosterone treatment options exist that can relieve the symptoms of decreased testosterone and can help men reclaim their lives.

Bottom Line: Testosterone deficiency and the accompanying symptoms of decreased libido, lack of energy, and loss of muscle mass is a common condition that affects millions of American men.  The diagnosis can be easily confirmed with a blood test and the treatment using testosterone replacement therapy can be achieved with several treatment options.

Oh Where or Where Has My G-Spot Gone

April 13, 2010

When news of the Grafenberg Spot – or G-Spot as it is more commonly known was first released, physicians, and the public at large, were skeptical.  Could it possibly be true?  The discovery of a tiny spot within a woman’s vagina, when stimulated, produced orgasms that were significantly more intense than clitoral orgasms.  Since the discovery of the G-Spot in 1980 extensive research has proven that it does exist.

Most of today’s women, being more sexually curious than their mothers and grandmothers, have at least heard about the G-Spot and its exciting capabilities.  However, many are still wishing they had a map that would direct them to this illusive treasure.  The G-Spot is difficult to find.  It takes patience to locate the G-Spot.  Once located, however, there is an unlimited richness in sexual pleasure that may be derived from stimulating the G-Spot.   Women who have discovered it state that the feeling is quite indescribable but definitely worth the search!

How fortunate the human male is!  From his first experience, a man’s orgasm is usually achieved quite easily.  On the other hand, despite the fact that we live in a more enlightened society, there are many women who fail to experience even the mildest form of orgasmic release – some of whom have been involved with their partners for years and years.

Learning to relax and feel comfortable with one’s own body – and its many functions – including those that bring us intense sexual pleasure – is definitely a perquisite to achieving the G-Spot orgasm.  A woman must be willing to explore her body, or allow her partner to explore it with her – telling him as he goes what does or does not feel good to her.

Because of the location of the G-Spot within the vagina, it is often difficult to reach.  The G-Spot is located in the front part of the body:  it is usually found on the upper front wall of the vagina.   For initial exploration purposes – at least until a woman becomes comfortable with the location of her G-Spot-it may be more beneficial for the woman to manually search while she sits on the toilet.

Before you start, wash your hands thoroughly and cut and smooth the fingernail of the finger you will use to explore.  This is to ensure that you won’t accidentally scratch yourself.  Empty your bladder, and focus on all the sensations in your pelvic region as you do so.

If necessary, lubricate your middle finger with a glycerine-based (water soluble) lubricant, such as K-Y jelly.  Explore the upper front wall of the vagina, exerting firm pressure in the direction of the navel.  Don’t be afraid of pressing down on the tissue as the G-Spot is a bit beneath the surface of the vaginal wall.

What you should be feeling is slight to moderate pleasure … you will feel a special kind of sensitivity when you press on the G-Spot.  Once you’ve located the G-Spot, continue stimulating the area, keeping in mind that considerable pressure will be needed to get good sensations.  You may experience twinges or contractions of the uterus while stroking the G-Spot … this is normal as the uterus is an enlargement of this sensitive area.  The spot may begin to swell … causing the tissue to become smooth.  The Grafenberg Spot will become quite obvious, feeling much like a lima bean or an almond beneath the surface of the vaginal wall.

Most women do not reach orgasm the first time they engage in sex play – whether the sexual act is masturbatory or intercourse with their partner.  While the acts themselves many feel very good, they are not usually sufficient – the first time around – to bring the woman to orgasm and climax.  She must first learn to relax deeply enough to fully experience all the sensations and pleasures she is feeling!  In short, she must train her mind to accept what her body is experiencing as a natural, normal – and totally acceptable – part of her life!

Some women have reported that the G-spot orgasm did not seem to be any different from the clitoral orgasms they’d already experienced.  The feelings and sensations associated with the G-Spot are very different from those experienced during clitoral orgasm  Because it is highly likely that the clitoris will, in some way, be stimulated during your exploration for the G-Spot, you may wish to have a clitoral orgasm first before proceeding!  This will ensure that stimulation of the G-Spot will result in a G-Spot orgasm!

Cystitis-How To Leave Home Without It

April 13, 2010

What does sex, bubble bath and thongs have in common?  Answer: They may all be causes of cystitis.  If you are a woman who has ever suffered from cystitis then you will know just how debilitating and miserable it can be, you you can perhaps take comfort from the fact that you are far from alone.  It seems that at last 20% of women have had an attack at some point in their lives, and 20% of those will get more than one episode a year.

There is certainly no mistaking the feeling it brings, which usually starts with a strong sensation of needing to urinate.  When you try to go, it either burns horribly, or nothing seems to come out.  You may have a full, uncomfortable sensation in the bladder, plus an aching back and stomach and a general feeling of being unwell.  The most common cause is an infection caused by bacteria.  It isn’t only a female problem but far more common in women than men.  The reason is that the internal plumbing of women is much shorter than in a man and the relationship of the rectum which is usually the source of the bacteria is closer to the urinary tract in women than in men.

A bacteria, called E. Coli, is usually the culprit.  Since E. Coli coming from the rectum can reside in the vagina and then can have easy access to the urethra or the tube that transmits urine from the bladder to the outside of the body.  This is why it is beneficial for women to wipe from front to back when they use the restroom.  If you swipe the wrong way, you can move the bugs from the rectum into the vagina and then into the urethra.  Another recommendation is to switch from nylon or synthetic underwear to the cooler cotton briefs which discourage the growth of bacteria.  Also, thongs and G strings may be very sexy but they are bad news for cystitis sufferers as the string is an effective way for bacteria to hitch a ride from your bottom to your bladder.

Another suggestion is to change the bacterial flora of the gastrointestinal tract.  This can be accomplished by regularly eating yoghurt which contains the good bacteria lactobacillus or acidophilus.

It is also crucial to drink large quantities of water to flush away any bacteria.  Also, it is recommended that sufferers of frequent cystitis go the toilet when you first feel the urge.  The longer you hold in urine, the fuller your bladder is, with more potential for bacteria to grow and proliferate.  Using bubble baths or irritating soaps around the vagina should also be avoided as these agents can upset the delicate balance of acidity and alkalinity in your skin so that bacteria can flourish.

It also appears that sexual intercourse, promotes moving bacteria from the vagina into the urethra.  This then starts the process of bacterial multiplication in the bladder and creates the symptoms of cystitis.  Therefore, it is important for women who get cystitis after intercourse to urinate frequently after sexual intimacy to wash the bacteria out of the urethra so they don’t become permanent residents and create an infection.

For years doctors have recommended cranberries of a method to reduce the attacks of recurrent cystitis.  Initially, it was thought that the cranberries were a source of acid and this prevented cystitis.  Now research has shown that the cranberries contain chemicals that help stop the bacteria from sticking onto the bladder wall.  Because cranberry juice can be quite high in sugar, you might prefer to take one of the cranberry supplements that are available.

Beating back an attack

The first practical step is to consume 2 glasses of water every 20 minutes for the first three hours.  This will help you ladder to flush itself out, and sometimes is enough on it s own to prevent further problems.  If not, gulp down a few glasses of cranberry juice.  Sipping a glass of water with a teaspoon of bicarbonate of soda stirred into it may help the burning sensation when you urinate.

If these simple measures don’t relieve your symptoms in a day or two, you may need to see your doctor and take a short course of antibiotics.  Failure to treat the infection can result in a much more serious kidney infection.  Also, if you have more than 3-4 infections in a 12 month period you will want to see your doctor to be sure there isn’t something else more ominous causing these infections.

When Your Urine Turns Red

April 13, 2010

Most men have an ejaculate (the fluid that contains the sperm) that is white and slightly cloudy.  When it turns red, it is a frightening occurrence.  Hematospermia, or blood in the ejaculate, is a symptom that provokes great anxiety in patients due to fears of malignancy or sexually transmitted diseases. For most men, hematospermia is not a serious, life-threatening condition.

One could think of blood in the semen in almost the same way one would think of blood in nasal mucus when one has a bad cold or sinus infection. It certainly is a sign of problems, but it’s nothing to panic about. Seeking a medical opinion is highly recommended in any instance.

Most men with hematospermia usually report brownish to red discoloration of the ejaculate. More than 90% of patients have no prior genitourinary symptoms or significant factors in their history. The ages range from 14 to 75, with an average age in the late 30’s. It is not uncommon, however, for it to affect men between the ages of 30 and 40. About 90% of men who have had hematospermia will have repeated episodes.

The cause is not specifically known and is poorly understood. Most commonly, it results from nonspecific inflammation of the urethra, prostate and/or seminal vesicles.

In about 50% of patients the cause of hematospermia is not clearly understood or known. Semen originates from multiple organs, including the testicles, epididymis, vas deferens, seminal vesicles, and prostate. Most of the semen comes from the seminal vesicles and prostate and it is probably from these two organs that most hematospermia cases originate.

Infections or inflammation of the organs listed above account for most of the other causes. Cancers are rarely causative and account for a very small percentage of hemospermic diagnoses.

With the introduction of ultrasound-guided prostate biopsies, we are seeing a large number of patients — about a third of the patients who received the test — with hematospermia after the biopsy.

Patients with hematospermia are usually categorized into one of two groups. The primary hematospermia group is where the patient’s only symptom is blood in the ejaculate. This means that there is no blood in the urine (neither visually nor under a microscope). Also, the patient has no symptoms of urinary irritation or infection and the physical exam is completely unremarkable. Patients who have this type of hematospermia with no other findings are essentially found to have no other problem. The condition is “self-limited”, which means it will go away in time without treatment. About 17% of patients will have one episode and no recurrence.

Secondary hematospermia is when the cause of bleeding is known or suspected, such as immediately after a prostate biopsy, in the presence of a urinary or prostate infection, or cancer. Unusual causes include tuberculosis, parasitic infections and any diseases that affect blood clotting such as hemophilia and chronic liver disease. Patients who have hematospermia associated with symptoms of urinary infection or visual and/or microscopic blood in the urine require a complete urologic evaluation.

Most men with hematospermia are in their 30’s and the problem almost always subsides spontaneously, usually within several weeks. Hematospermia may be associated with infection, but is rarely secondary to malignancy. Patients that have persistent hematospermia for longer than three weeks should undergo further urologic evaluation to identify the specific cause.

The physical exam should include a genital and rectal exam, as well as a blood pressure test. Hypertension can be associated with hematospermia. Some urologists recommend transrectal ultrasounds to look for stones and cysts in the prostate, seminal vesicles and ejaculatory ducts. This may also help rule out prostate cancer.

Other urologists recommend cystoscopy because hematospermia can be secondary to urethral and prostatic pathology. Overall, hematospermia almost always resolves spontaneously and rarely is associated with significant urinary pathology. In a Japanese study, less than 1% of patients had prostate cancer associated with hematospermia.

Hematospermia can be a very frightening occurrence to any male, but in the end, most of these patients are found to have no abnormalities and require no therapy. Hematospermia is prone to continue on and off, but it is usually self-limited and carries no increased risk of any other disease, nor is the patient felt to be putting his sexual partner at risk. To reiterate; malignant cancers of the testicles and prostate are very rarely associated with hematospermia.

Bottom line-hematospermia is a frightening condition that suggests a mild inflammation of either the prostate gland or seminal vesicles.  No treatment or use of medication will result in return of the semen to its normal color.  If you have this condition, check with your doctor or your urologist.

EjD, Ejaculatory Dysfunction-The New Sexual Dysfunction

April 11, 2010

Millions of men suffer from EjD or ejaculatory dysfunction.  The most common variety is premature ejaculation followed by retarded ejaculation or not being able to achieve an orgasm.  Another less common EjD is retrograde ejaculation or seminal fluid going back into the bladder instead of exiting the penis at the time of orgasm.  This article will discuss the three common EjD conditions and what can be done to resolve them.

It is estimated that one-third of American men suffer from premature ejaculation or ejaculation within seconds of vaginal penetration.  This is of great concern and embarrassment to those who experience this malady.

One folk remedy that is available to all men is self-stimulation or masturbation. Having repeated orgasms will bring on delayed ejaculation in nearly every man. The best premature ejaculation tip is to double the number of orgasms a man has per week. And if that doesn’t work, double it again.  Now isn’t that a great assignment?

Another method that requires cooperation with the partner or significant other is the “pull out technique.” This consists of having sex for a few minutes then pulling out and stopping for a few minutes to postpone orgasm.

Another method is to decrease the stimulation of the penis using desensitizing cream such as topical xylocaine.  Also, using one or more condoms can decrease the sensation and can prolong ejaculation.

When these non-pharmacologic techniques are ineffective there are medications that can help prolong the time from penetration to ejaculation. Selective serotonin reuptake inhibitors, or SSRIs — are known to cause delayed ejaculation.  Using an SSRI four to six hours before intercourse, men prone to premature ejaculation can last longer.

Delayed ejaculation (or retarded ejaculation) affects a much smaller number of men.  With this problem, men cannot reach orgasm at all, at least not with a partner.  It is most common associated with aging where more stimulatin is required for a man to reach an orgasm with advancing years because the nerve endings in the penis become less sensitive.  Delayed ejaculation may be caused by medicines – like antidepressants– are common culprits.

Retrograde ejaculation is the least common of the ejaculation problems. Retrograde ejaculation can be caused by diabetes, nerve damage, and various medications such as alpha-blockers like Flomax, which are used to treat enlargement of the prostate gland. Retrograde ejaculation is harmless and won’t interfere with the feeling of orgasm. (It can also make for an easy post-sex clean-up.) But since it does affect fertility, some men may need treatment if their partners are trying to get pregnant.

Bottom Line

EjD is a common medical condition that can be overcome.  Be open and communicate with doctor and share your concern with your partner.  Don’t suffer in silence and let the tension mount up and compounding the problem.  Most men with some advice and perhaps some medication from their doctor can overcome this problem.  This translates to less worry and more sex.  Who could ask for anything more?