Archive for May, 2013

Erections Not As Good As You Like? It May Be The Pain Medication That Prevents You From Getting It Up

May 30, 2013

Back pain is one of the most common afflictions for both men and women. It appears to be the price we pay for walking erect with compression of the bones of the spine, which impinge on the nerves to the back and lower extremities. One of the most commonly prescribed medications for low back pain are opoids. Men using long-term, high-dose prescription opioids for back pain are more likely to be using medications for erectile dysfunction such as Viagra, Levitra, Cialis or testosterone.

Bottom Line: Men should be aware that erectile dysfunction is a potential side effect of long-term, high-dose opioid therapy. Doctors and patients should be aware of this when considering options for chronic pain management, especially because non-pharmacologic treatments—such as rigorous exercise and cognitive-behavioral therapy—may be at least as effective.
Findings from the study were published in Spine (2013; 38:909-15).


Sex After a Heart Attack: What You Need To Know

May 29, 2013
Your Average Middle Age Couple Who Are In Love And Wish To Be Sexually Active

Your Average Middle Age Couple Who Are In Love And Wish To Be Sexually Active

Every man or woman who has had a heart attack has concerns when they can begin having sexual intimacy after recovering from a heart attack. Certainly the movie, Something’s Gotta Give with Jack Nicholson and Diane Keaton, offers the protagonist advice about engaging in sexual intimacy after a heart attack until the man can climb two flights of stairs without shortness of breadth or chest pain. Every woman is concerned whether resuming sexual activity may trigger another heart attack in her partner. We know depression is extremely common after a heart attack, especially for women. This blog will attempt to answer some of those questions that men and women have after a heart attack.

First, most cardiologist believe it is helpful for men to be in a supervised exercise program. These cardiac rehab programs teach men and women that it’s OK for them to exercise after a heart attack.

However, if you begin to feel symptoms such as chest pain, abnormal shortness of breath, fatigue, dizziness, or palpitations, it definitely makes sense to slow down what you’re doing, whether you’re a man or a woman. If you’re pretty certain it’s angina, which is temporary pain or pressure in the chest when the heart doesn’t get enough oxygen, it might help to take your nitroglycerin tablet under your tongue.

Now the warning: Just like the movie, Something’s Gotta Give, men who use medication for erectile dysfunction, such as Viagra, Levitra, or Cialis, — they should not take nitroglycerin. Your blood pressure can fall to dangerously low levels, and there’s an increased risk of heart attack and even death. If you’re on an erectile dysfunction drug and have heart-related symptoms during sex, call your doctor.

Yes, and sexual intimacy is often related to the emotions that follow a diagnosis of heart disease. It influences people’s lives in many different ways, and sexual activity is one of them. A new diagnosis of heart disease — or even a surgical scar — can make people feel less attractive. Some drugs have side effects that diminish sexual interest and performance. When patients feel angry and frustrated, it affects not only their sex lives but also their “couple” relationships.

Sexual intimacy is like a stress test. Engaging in sex shows that you’re capable of doing physical activity in which your heart rate and blood pressure go up. In a sense, you’re doing a stress test on your heart. If you tolerate that well and you feel good doing it, it suggests good things about your overall level of fitness and therefore your risk of heart disease.
Sex can also be a sign of healthy relationships and social supports. It shows you have the opportunities, frankly, and that you’re interested and engaged. Sex is a barometer for overall health.

Bottom Line: Sex is a good thing and sex is okay after a heart attack if your doctor gives you permission to exercise and engage in sexual intimacy. This is a discussion every man and woman needs to have with their doctor after having a heart attack and before leaving the hospital.

All Men Are Created Equal but Not Sunscreens

May 26, 2013
Whenever You or Your Family Is In the Sun, Use Sunscreen

Whenever You or Your Family Is In the Sun, Use Sunscreen

Summer is here and it’s time for anyone who is going to spend time in the sun to start thinking about sunscreens. Sunscreen is measured by the SPF or sun protection factor. The sun protection factor of a sunscreen is a laboratory measure of the effectiveness of sunscreen — the higher the SPF, the more protection a sunscreen offers against the ultraviolet radiation that causes sunburn and even skin cancer. In its new sunscreen ratings evaluation, Consumer Reports found that paying more for sunscreen doesn’t always mean better protection. Some of our best products were also the least expensive.

Some of the pricier sunscreens, in fact, did not live up to the SPF (sun protection factor) value on the label, the testers found. Two sunscreens — All Terrain AquaSport SPF 30 and Badger Unscented SPF 34 — were rated poor in protecting against ultravilot rays.
Top Sunscreens This Year
Consumer Reports regularly rates sunscreens, and this time picked 12 popular products from a variety of stores. They took into account protection from UVA and UVB, how much the product stained clothing, and the cost per ounce.
Six got recommended ratings:
• Target’s Up & Up Sport, at the top spot, costs $1.16 an ounce.
• Walmart’s Equate Ultra Protection SPF 50, is just 47 cents an ounce. It won the CR Best Buy award of the dozen.
• Coppertone Water Babies SPF 50, at $1.38 an ounce.
• Walgreens Continuous Spray Sport SPF 50, at $1.33 an ounce.
• Hawaiian Tropic Sheer Touch SPF 30, at $1.38 an ounce.
• Coppertone Sport High Performance SPF 30, at $1.67 an ounce.

The six that didn’t get recommended ratings include:
• California Baby SPF 30+, at $6.90 an ounce (discontinued, but may still be available).
• No-Ad with Avobenzone, Aloe, and Vitamin E SPF 45, at 63 cents an ounce.
• Neutrogena Wet Skin SPF 45+, at $3.67 an ounce.
• Kiss My Face with Hydresia SPF 40, at $5.33 an ounce.
• Badger Unscented SPF 34, at $5.52 an ounce (discontinued, but may still be available).
All Terrain AquaSport SPF 30, at $4.33 an ounce.

Bottom Line: If you are going to spend any significant time in the sun, be sure to use a good sunscreen with an SPF of at least 50.

Pelvic Pain-May Be Caused By Birth Control Pills

May 25, 2013

Birth Control Pills With Estrogen

Birth Control Pills With Estrogen


Low-dose oral contraceptives might increase the incidence of chronic pelvic pain in young women, especially during sexual climax, a new study suggests. This is a side effect that is not discussed and is not in the package insert.
Current oral contraceptives contain very low-dose estrogen, which causes changes in serum estradiol, free testosterone levels, hormonal receptors, and vulvar mucosa. The researchers hypothesized that this could result in pelvic pain.

Low-dose estrogen users were significantly more likely to meet the criteria for a diagnosis of chronic pelvic pain than nonusers.

Bottom Line: If you have chronic pelvic pain and are using low dose estrogen birth control pills, you may want to speak to your doctor about changing your medication to a birth control pill that does not contain low estrogen.

Man Has Prostate Gland Removed Because He Tested Positive For The BRCA-Gene

May 25, 2013

BRCA-2 Gene

BRCA-2 Gene


Angelina Jolie has come forward and shared with the world her story about having prophylactic bilateral mastectomies and breast reconstruction after learning that she tested positive for the BRCA2 gene mutation that is highly predictive of developing breast cancer.

BRCA gene mutations increase the risk for a number of cancers, including prostate cancer. Now the first man has come forward who tested positive for the BRCA gene mutation who had his prostate gland removed. The surgery took place in London by an eminent surgeon who also had his prostate gland removed for prostate cancer after prostate cancer was found.

Previous results from this trial have shown that a man with a BRCA2 mutation has an 8.6-fold increased risk of developing prostate cancer, and with a BRCA1 mutation has a 3.4-fold increased risk. The same researchers reported that prostate cancer in men with the BRCA2 mutation is more aggressive and more likely to be fatal (J Clin Oncol. 2013;31:1748-1757).

The man who underwent the surgery is described as a 53-years-old businessman from London who is married with children and has several family members who have had breast or prostate cancer. When he found out he was carrying the BRCA2 mutation, he asked to have his prostate removed.

What’s my opinion on this first test case of prophylactic prostate gland removal for men with BRCA gene mutation? First, I don’t think American insurance companies, including Medicare, will pay for prophylactic prostatectomies without a diagnosis of prostate cancer confirmed by a prostate biopsy. Second, I wouldn’t recommend a prostatectomy just on the basis of a positive gene test. I think it is far too early to be removing men’s prostate glands with the associated risk of erectile dysfunction and urinary incontinence just on the basis of a blood test. However, if a man with an elevated PSA blood test has one or two relatives such as a father or brother with prostate cancer and a mother with breast cancer and it is highly likely that he may have or will develop prostate cancer, then I would certainly recommend that the man have a prostate biopsy and close monitoring for prostate cancer.

I do suggest that all men with a family history of prostate cancer have an annual digital rectal exam and a PSA blood test.

Stress Getting You Down-It May Also Be Affecting A Man’s Fertility

May 19, 2013

Stress just may have an impact on a man’s sperm quality. Men with higher levels of stress and anxiety have lower sperm counts. Also those with the highest anxiety levels were also more like to have sperm that are less motile or have the ability to swim through the cervical canal to find an egg in the tubes connecting the ovary to the uterus. This report appeared in the February 13, 2013 issue of Fertility and Sterility.

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.

BRCA Gene Mutation and What It Means For Men

May 18, 2013

Everyone knows that Angelina Jolie had a double mastectomy as a prophylaxis against developing breast cancer. I think every woman can appreciate how brave she was to undergo the surgery but also how she put this issue on the map and increased the awareness of the BRCA gene. Since Angelina had the mastectomy she has reduced her risk of breast cancer from a dismal 87% to a manageable 5%. But what does the BRCA gene mean if a man carries the gene?

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)

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

PSA Testing -To Screen Or Not to Screen-What the Experts are Saying

May 12, 2013

Prostate cancer is the most common non-skin cancer in men with 250,000 new cases every year. The disease can be detected by screening with a PSA blood test and a digital rectal exam. Some men with prostate cancer will go on to treatment and are at risk for complications including impotence or erectile dysfunction and urinary incontinence or leaking urine.
The American Urologic Association has just released new guidelines for prostate cancer screening that I would like to share with you and hope that you can use this information to make a decision if prostate cancer screening is appropriate for you.

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-Sex and Painful Testicles

May 12, 2013

You are a young man. Just getting started with sex and engage in heavy petting resulting in sexual arousal. After 45 minutes of heavy petting, you have an ache and discomfort in your testicles. What is this? What should you do?

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-When It Hurts Down There During Sexual Activity

May 11, 2013

Screen Shot 2013-05-11 at 12.51.26 PMNearly every young man has had the experience of intense sexual stimulation and an aching sensation in his testicles. It is common in young men just experiencing sexual activity and has been a source of pain and discomfort for nearly every man who embarks on his sexual career.

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.