Doctors hear it all the time: “My wife made me come in.” That’s often an opening line from men who find themselves in one of their least favorite places to be — the doctor’s office.
“The wife is usually the watch dog for health in the family and the motivation behind a lot of men going to see their doctor,” said Dr. Scott Owens of Urology of Central Pa. in Camp Hill.
Sometimes men are embarrassed about the issue, which explains their hesitancy to see a doctor, and other times, they just don’t see the need unless they are really sick. However, doctors say that men should get regular physical exams and pay attention to issues that could become future health concerns if not addressed early.
“There are screening tests that I would recommend for every man and these are important to good health,” said Dr. William Nasuti of PinnacleHealth FamilyCare Silver Spring. “Between age 20 and 30, every man should be screened for a complete blood count, or CBC; chemistry profile, which checks for diabetes, liver abnormalities and electrolyte disorders; lipid profile for high cholesterol, which is the leading cause of coronary artery disease and strokes, and a thyroid screen to see if you have overactive or underactive thyroid disease.”
Nasuti also recommends that men have an annual hernia and testicular exam and, after age 50, an annual rectal exam. A colonoscopy should be scheduled at age 50 and if normal, again in another 10 years, he said. Smokers should try to quit and men should drink no more than one or two drinks daily, he said. “Excess alcohol will catch up to you in problems with your liver, hypertension or diabetes,” he said.
Other common conditions that men should seek out a doctor for include:
Pneumonia
Pneumococcal disease, caused by streptococcus pneumoniae bacteria, is a leading cause of vaccine-preventable illness and death in the United States.
Pneumococcal disease can lead to serious infections of the lungs, blood and covering of the brain, Nasuti said.
Pneumococcal pneumonia kills about one out of 20 people who get it. The vaccine protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease, according to the Centers for Disease Control and Prevention.
Men (and women) should get the vaccine starting at age 65 and repeated every 10 years thereafter, Nasuti said. Men who have certain conditions such as premature heart disease, diabetes or emphysema should get the vaccine on diagnosis, he said.
Only about 60 percent of men aged 65 and older get the vaccine, although pneumonia is a common cause of hospitalization in men, according to the CDC.
“A quick immunization can prevent some life-threatening illnesses,” Nasuti said.
Erectile dysfunction
Difficulty getting or sustaining an erection, especially after age 50, is more common than men think it is.
“Many men wouldn’t bring this up to a doctor. It’s an ego issue. Men somehow think to admit erectile dysfunction is to admit you’re losing your manhood, which is not true,” Owens said. “Their quality of life is affected, but they’re not willing to admit it and so they don’t know treatment is easy.”
The causes are varied. In younger men, if there’s no physical reason, the cause could be psycho social stressors or performance anxiety, Owens said. People with diabetes could have problems with blood flow. Men over age 50 could have vascular disease, performance anxiety or — and here’s s big one — alcohol can affect erection, Owens said.
“The treatment is medication that works by dilating the blood vessels to the penis to help achieve or sustain erection,” he said. Men take Viagra to get an erection within a half hour while the daily pill Cialis lasts up to 48 hours and offers more spontaneity, he said.
Low testosterone levels can also decrease sex drive and ability to get an erection, Owens said. This happens when the testicles aren’t producing enough testosterone anymore, a condition that can be detected with a blood test.
All men after age 50 experience some decrease in testosterone level, Owens said. Whereas a healthy man in his 30s might have total testosterone levels of 500 to 700 nanograms per deciliter, a 70-year-old man might have a level of less than 300.
“This is treatable with testosterone replacement therapy in the form of a monthly injection or creams applied to the back or shoulder that are absorbed into the skin,” Owens said.
Depression
Depression is a very common yet under-diagnosed problem in men, according to Nasuti.
“Men may see it as a sign of weakness and so it goes under-treated,” he said. “Change of mood, sleep disturbance, irritability, lack of interest, anxiety — all of these can be tied back to depression.”
A combination of an antidepressant such as a selective serotonin reuptake inhibitor and counseling can be very effective at combating depression, Nasuti said.
Enlarged prostate
For men over age 50, a common problem is an enlarged prostate, which is the male reproductive gland that produces fluid that carries the sperm during ejaculation.
“A slow stream of urine or dribbling, getting up at night more to urinate or urgency or frequency — these are all symptoms of an enlarged prostate,” Owens said. “Nobody knows the cause.”
Urinary symptoms can be eased by medications such as Tamsulosin (brand name Flomax) that work by relaxing the muscles in the prostate and bladder so that urine can flow easily, Owens said.
In some cases, surgery may be necessary, he said. A scope is inserted through the penis and a small incision is made in the prostate tissue to enlarge the opening of the urethra and bladder outlet.
To screen for prostate cancer, Owens recommends a baseline prostate specific antigen (PSA) test after age 40 and every three to five years thereafter.
Testicular swelling
Testicular swelling merits immediate attention, Owens said.
“Testicular cancer is the most common solid malignancy in men ages 20 to 40 and presents with a painless mass in the testicle,” he said. “If you ignore it for even three months, it can have spread. If you have painless scrotal swelling, have it checked.”
A painless, swollen testicle is also a symptom of a hydrocele, a fluid-filled sac within the scrotum, he said. If pain accompanies the swelling, it’s more likely caused by an infection, Owens said.
Abdominal aortic aneurysm
The aorta is the main blood vessel that carries blood from the heart to the rest of the body. An abdominal aortic aneurysm occurs when the lower part of the aorta — the part that goes through the abdominal area — begins to dilate and the walls weaken.
“If there is a rupture, this is a surgical emergency, and the outcomes are not good,” Nasuti said.
Symptoms include back or abdominal pain or a pulsating mass in the abdomen on physical examination, he said. The doctor will watch it until it becomes greater than 5 centimeters, in which case surgery can be done to repair it.
Because symptoms may not show up until there is a life-threatening emergency, a screening by ultrasound of the aorta is recommended after age 65 to 70, Nasuti said. This may or may not be covered by insurance.
Medicare offers a one-time, free abdominal ultrasound screening to men who have smoked at least 100 cigarettes in their lifetime or have a family history of abdominal aortic aneurysm.
Causes include smoking, years of uncontrolled high blood pressure and a genetic predisposition, Nasuti said.
Men’s health by the numbers
* 12 — Percentage of men 18 years and older in fair or poor health
* 23 — Percentage of men 18 years and older who currently smoke
* 31 — Percentage of men 20 years and older with hypertension
* 33 — Percentage of men 20 years and older who are obese
* 37 — Percentage of men 18 years and older who engaged in regular leisure-time physical activity
SOURCE: Centers for Disease Control and Prevention
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