Man Friday: Dr Phil Kieran on men's sexual health

Sexual health is sometimes overlooked, so don’t leave it to the last minute to ask your doctor about it, writes Dr Phil Kieran

Man Friday: Dr Phil Kieran on men's sexual health

Sexual health is sometimes overlooked, so don’t leave it to the last minute to ask your doctor about it, writes Dr Phil Kieran

‘AND just before I go, doctor. There’s something I just want to talk to you about quickly…”

It’s such a common way for a patient to bring up and an awkward topic that in medical research it has it’s own name: The doorknob syndrome.

This sentence almost always comes just before one of two topics. Either the person needs to talk about their mood or else it’s a sexual problem and, generally this issue is the main reason they come to see me.

Sometimes the fact that you have known your GP for some time makes you embarrassed to talk to them about this kind of thing and if that’s the case then going to a specific sexual health clinic may be easier, but you really shouldn’t be embarrassed about it.

I can pretty much guarantee you can’t say anything that would shock your doctor, or that they haven’t heard before. Please don’t leave this issue to the end of your consultation either. The doorknob syndrome is bad for your health because it means your doctor has less time to deal with an important issue.

Sexual health shouldn’t be something we ignore until we get a scare as anyone who has had unprotected sex should consider getting screened. Most infections are completely asymptomatic particularly in the early stages so testing is essential.

What does sexual health mean?

I’m talking here mainly about sexually transmitted infections (STI’s) but, in reality, sexual health goes a lot further than this. It should encompass your attitudes, safety and enjoyment of sex. Sex is something that a lot of people experience difficulty with at some stage and I would recommend to patients fairly frequently, that they go and talk to a counsellor who specialises in psycho-sexual counselling. The root of a lot of sexual problems is psychological rather than physical.

Why men need to be concerned

STIs affect both sexes but men tend to worry about STIs less and are affected more. Last year of the 11,000 STIs diagnosed, men made up nearly 6,000 cases.

The most common STI is HPV which is the virus which causes genital warts and can cause cervical cancer in women, penile/anal cancer in men and head, and neck cancers is both. The true number of people who have HPV or have had it in the past is difficult to know as it often goes unreported to the Health Protection Surveillance Centre (HPSC), which gathers the statistics on infectious illnesses in Ireland.

Working in a GP surgery, I can safely tell you genital warts are very common and cause quite a lot of distress (they can often be effectively treated with a liquid nitrogen spray or creams).

The next most common infections are chlamydia and gonorrhoea, bacterial infections that can infect the tube which goes from the bladder to the penis (Urethra), the throat or the anus. Less common but still very definitely around in the population are HIV, syphilis, herpes and hepatitis B.

How do I find out?

Get checked. Chlamydia has no symptoms in up to 50% of men but can cause at least two significant problems. First, it has been associated with lower sperm counts and, second, it can cause an increase in the numbers of abnormal sperm. It is also important to find and cure this infection as if you pass it on to a female partner there is a real risk of causing permanent infertility for her.

Gonorrhoea usually has symptoms of discharge from the tip of the penis and/or some burning when you pass urine. It can be asymptomatic and it is something we would always test for as part of a sexual health screen.

Getting tested has never been easier or more accurate. The test will usually involve the doctor asking questions about your sexual history. This is to figure out the likelihood of you having specific infections so be honest. Then you will often be offered a physical exam of the genitals this is to look for any lumps bumps or signs of ulcers.

A blood test is done to check for HIV, syphilis and hepatitis and then a urine test is sent for chlamydia and gonorrhoea. You may have heard horror stories about needing to have a swab inserted into the penis but now thankfully this is almost never necessary. For the urine test it is important to have not gone to the toilet for 90 minutes beforehand as this can wash the bacteria away and give you a false negative result, so if you find yourself bursting to go while still waiting to be seen ask the receptionist for a sample container. Make sure that when you pee, that the very first few drops go into the bottle as this is the most accurate part of the sample for STI screening.

An option that is becoming more popular is to take the swabs yourself (the doctor will tell you how), give a urine and blood sample and avoid the physical exam. This is a perfectly reasonable way to do STI screening and has the benefit of not having an intimate exam done if you aren’t comfortable or too embarrassed. The big downside to this is that there is no exam of testicles to look for testicular cancer and no check for warts or ulcers.

How to fix it (without meds)

Prevention is better than cure so use condoms. Regular screening is a good idea too and although you have the potential for catching an STI from any episode of unprotected sex, it is probably reasonable to get tested every three to six months depending on your individual lifestyle. For anyone entering a stable relationship and considering not using condoms it makes sense for both partners to get checked before hand.

How to fix it (with meds)

That covers how to not catch an STI but what if you do? Well, the good news is that treating some infections can be as simple to treat as a single dose of antibiotics. This is particularly true for Chlamydia and gonorrhoea. For infections like syphilis further testing is usually needed and for HIV you will need lifelong follow up — the treatment is very effective.

On a different note with the HPV vaccine and, hopefully, it will be available for boys going forward we should see not only a decrease in cancers but also a large reduction in genital warts.

What it all boils down to though is protect yourself as you simply can’t tell if someone carries an STI.

And don’t be embarrassed about getting checked once in a while.

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