80 per cent of men would rather be ill than admit to a problem

DR ELLIE CANNON: Don’t be one of the 80 per cent of men who’d rather be ill than admit to a problem

Is the cliche true – are men reluctant to talk to doctors about their health? Surveys paint a depressing picture: up to 80 per cent of men questioned by Bupa recently said they would rather endure an illness than seek help.

In my own surgery, men under the age of 40 are an unusual sight. Although we do get more middle-aged blokes coming in, often to have a heart health check-up, I’d say two-thirds of my patients, generally, are women. There are many reasons for this.

Women are more used to seeing doctors, having often gone through the process of having a baby, with all the check-ups and visits that involves before, during and for years after. Regular screening for cervical cancer, from their mid-20s, and breast cancer in middle age, is another reason.

And, no doubt, some men feel pressure to ‘be a man’ and not talk about their problems. Nowhere is this more apparent than with ’embarrassing’ ailments.

Up to 80 per cent of men questioned by Bupa recently said they would rather endure an illness than seek help

‘Physical stuff around genitals is something most guys will find difficult to talk about,’ says Jim Pollard from the Men’s Health Forum. ‘These things are tied up with notions of masculinity – and men don’t like sitting in a doctor’s surgery admitting they don’t know what’s wrong.’

The key thing to remember, as Dr Kaye has already pointed out on the previous pages about women’s health, is that we GPs have seen all of this before.

Men can, and do, come and see me all the time with these things – and, of course, if you’d rather speak to a male doctor, we understand that.

In the meantime, here is my guide for dealing with the male ailments you might be shy to talk about – but really needn’t be.

THE QUESTION MEN MOST ASK GOOGLE BUT NOT ME

Suicide risk among men who won’t talk 

Men are significantly more likely to commit suicide than women because they struggle to admit they need help.

For many men, mental health issues remain a taboo subject, despite efforts to bring problems such as anxiety and depression out into the open.

Men’s Health Forum founder Jim Pollard says: ‘I think it’s embarrassing for men to say, ‘I don’t think I’m coping.’

Mental health charities, such as Heads Together, founded in 2016 by the Duke and Duchess of Cambridge, pictured, and Prince Harry, have been encouraging men to speak out

‘One guy told me he’d rather admit to not being able to get it up than admit he was struggling mentally.’

In recent years, mental health charities, such as Heads Together, founded in 2016 by the Duke and Duchess of Cambridge and Prince Harry, have been encouraging men to speak out.

Despite this, three-quarters of suicides are by men. Almost 5,000 killed themselves in 2018 compared with 1,604 women. According to the Samaritans, the highest rate of suicide is in men aged 45 to 49, and is the biggest killer in men under 35.

‘Women are more likely to seek treatment,’ Jim says. ‘We’ve run confidential and anonymous chat services for men’s mental and physical health issues, and in both cases the doctors said they got talking about issues that never came out in normal surgeries.’

A Samaritans spokesman added: ‘Suicide is rarely caused by one thing. There is a range of psychological, social, cultural and economic factors that influence suicide risk.’

For support, call the Samaritans’ free 24-hour helpline on 116 123.

It is, according to search-engine data, one of the most frequently asked questions relating to male sexual health: What are the spots on my penis?

Sexually transmitted infections are common, but also easily sorted. However, I often see a patient who’s worried himself unnecessarily – or worse, tried to self-treat – when the problem is entirely benign.

WHAT CAUSES IT?

Small raised bumps along the shaft of the penis that are pale red, yellow-white or skin-coloured are usually what we call Fordyce spots or granules.

They can also appear on the scrotum, and the lips, but they are totally harmless oil-secreting glands in the skin, and there is no reason to do anything about them. There are loads of home-remedies for sale on the internet, but these at best do nothing and at worst damage the skin. Avoid them.

Small white spots around the head of the penis, known as pearly papules, are also totally harmless and about a third of men have them. It’s also not unusual to get small red pimples, known as septic spots, which just go away after a week.

Genital warts are common – about 57,000 men get them each year. The colour depends on your skin shade but the characteristic appearance is of a ‘wobbly’ projection – like a tiny strand of seaweed.

They are caused by the human papillomavirus, or HPV, which is also linked with cervical, throat and anal cancers.

Genital warts are highly infectious and can be passed on through sex, but cases have been in decline thanks to the rollout of a vaccine against the virus offered to teenage girls (and, since September, also to boys).

Spots which are more like ulcers – but are usually painless – may be syphilis, a sexually transmitted infection (STI) which can also cause a rash on the hands and feet.

I know Dr Google may have diagnosed penile cancer, which is linked to the HPV virus, but this affects only 640 men a year in the UK.

WHAT CAN I DO?

If you want to save yourself the worry, just see a doctor and get a proper diagnosis.

Your GP, or a local sexual health clinic, will be able to test you for STIs and prescribe treatment – antibiotics for syphilis and a cream or minor surgery to burn, laser or freeze off genital warts. And if you are treated, and symptoms persist, make sure you go back to the doctor.

MYSTIFYING SCAR TISSUE CAUSING SEX PROBLEMS

Bodies come in a variety of shapes and sizes – and penises are no different.

Most men will worry at some point that their own isn’t ‘normal’, but it’s time to take note if there’s an obvious change – a more noticeable bend, for example, or even an hour-glass shape. 

This could be a sign of the usually harmless condition Peyronie’s disease. Normally only noticeable when erect, if any of these are accompanied by painful erections or erectile dysfunction then it should be checked out.

WHAT CAUSES IT?

Experts are still a bit stumped, but the change of shape is the result of scar tissue, or plaques, developing within the shaft. In some cases it happens following an injury sustained during sexual activity.

It’s also relatively common, affecting up to one in ten men, and is most prevalent in those aged 50 and over. It might also run in families.

While not harmful, it can be emotionally distressing, particularly if it affects sexual relationships, which can take a huge toll on mental health.

WHAT CAN I DO?

It can improve all by itself. But take advice from a GP or sexual health clinic. There are some potential treatments, including injecting steroids or using ultrasound therapy, but there is only limited evidence this works.

A change in penis shape is the result of scar tissue and while not harmful, it can be emotionally distressing, particularly if it affects sexual relationships

If the change in shape is severe and makes intercourse impossible, for instance, surgery to cut away the plaque or implant a device to straighten the penis is available as a very last resort.

Consultant urologist Asif Muneer tells me some patients find it easier to take pictures of the problem to save embarrassment when they seek help. ‘When I started, people were bringing in out-of-focus Polaroids,’ he said. ‘Now, thanks to mobile phone cameras, I can get a better idea of the problem.’

WHEN THE LOCATION OF A LUMP IS EVERYTHING

A lump in the testicles doesn’t always mean cancer, despite what Dr Google might suggest.

For every 100 men who find such a growth, 96 will discover it has a completely harmless cause. And often it might not even need any treatment at all.

Any change should be checked out straight away by a doctor, but there are a whole range of benign conditions that it’s more likely to be than cancer.

WHAT CAUSES IT?

Any lump behind or on top of the testicle might be an epididymal cyst – a harmless growth filled with liquid.

It’s more common in the over-40s and rarely needs treatment. 

This is diagnosed by a doctor shining a special light through the scrotum. If it’s an epididymal cyst, the light will shine through the liquid, if it is cancer, it won’t.

Other common lumps include varicoceles, distended veins just like varicose veins in legs, and hydroceles, which involve fluid accumulating around the testicle. 

An infection known as epididymo-orchitis, which causes the testicles to become painful and swollen, is the only issue that may need treatment with antibiotics.

But Robert Cornes, a specialist nurse at male cancer charity Orchid, says that as a general rule of thumb, any small, hard lump attached to the testicle should be checked in case it’s an early sign of testicular cancer.

WHAT CAN I DO?

While most lumps will be completely benign, do see a GP, urges Mr Cornes.

‘A quick examination will tell us what’s going on and, if not, an ultrasound on the testicle will be about 99 per cent accurate.’

It’s worth remembering, too, that testicular cancer is one of the most treatable cancers if caught early, with ten-year survival rates at 98 per cent.

WHAT CAUSES THESE MOOBS TO GROW? 

It’s the last thing men want to talk about. But weight gain around the chest area – sometimes described as ‘man boobs’ or ‘moobs’ – affects as many as 70 per cent of men over the age of 50.

Weight gain around the chest area – sometimes described as ‘man boobs’ or ‘moobs’ – affects as many as 70 per cent of men over the age of 50

WHAT COULD IT BE?

The clinical name is gynaecomastia and it’s generally harmless. But it can be uncomfortable, causing chafing and tenderness, and lead to feelings of depression and isolation. It generally develops because of a hormone imbalance between testosterone and oestrogen. When men pile on the pounds later in life, the extra body fat leads to a rise in oestrogen.

Testosterone levels, which normally keep oestrogen in check, also drop with age. Both can cause breast tissue to develop. In rarer cases it might be a symptom of liver cirrhosis, testicular cancer, kidney failure or an overactive thyroid, or a side effect of medication for an enlarged prostate or anti-psychotic drugs.

WHAT CAN I DO?

Most men won’t need to seek treatment. Losing weight can help. In some cases, usually in men who are otherwise slim, drugs can help suppress excess oestrogen.

Struggling to perform? Get a diabetes check 

All men will occasionally fail to either get or maintain an erection. It doesn’t mean there’s a serious or permanent problem.

Studies have shown that about 4.3 million men in the UK – one in five – suffer regularly from erectile dysfunction, and it’s thought to affect half of all men over 50.

Most men avoid talking to their GP – or their partner – about it. And yet it’s potentially really easy to solve.

WHAT CAUSES IT?

Stress, tiredness, anxiety or drinking too much alcohol are the most common causes of an intermittent problem.

But an erection also relies on having a healthy circulation, so in some cases it might be an early sign of more serious – but treatable – conditions such as heart problems or diabetes.

Men with diabetes are three times more likely to have erection problems, and it’s really common for patients to come to clinics seeking help with impotence only to find they’ve got diabetes.

WHAT CAN I DO?

Erection problems can be treated easily with drugs such as Viagra, which increases blood flow to the penis.

It’s available to buy over the counter in pharmacies, but the pharmacist will want to have a proper discussion about your health history first. For example, men who have previously had a stroke or heart attack shouldn’t take Viagra.

Those diagnosed with type 2 diabetes may be advised to lose weight or take medication to lower blood sugar levels, and if there’s any sign of cardiovascular disease a statin might be offered to reduce cholesterol. This in itself can help. You might be tested for your testosterone level too.

Just don’t be tempted to buy Viagra online – £17 million worth of unlicensed or counterfeit Viagra was seized in 2016 alone. At best, they won’t do anything, but at worst they could be dangerous.

‘Go and see your GP – don’t self-diagnose – and get your overall health checked,’ says Jim Pollard from the Men’s Health Forum.

NIGHT TIME TOILET TRIPS COULD BE A WARNING

Stumbling to the toilet in the middle of the night is nothing unusual, especially after a couple of pints at the pub. 

It’s often linked to advancing years and will, most likely, worsen with age.

But if it’s regularly happening several times a night, the need becomes more urgent, and if it’s affecting the quality of sleep, then it might be worth going to see a GP.

WHAT COULD IT BE?

There is a good chance it’s nothing more than an enlarged prostate – the walnut-sized gland underneath the bladder which produces semen.

According to health regulatory body NICE, 40 per cent of men in their 50s – rising to 90 per cent in their 80s – have the condition.

It is a completely normal side effect of ageing.

However, it puts additional pressure on the bladder, which causes men to feel the need to urinate more frequently.

Men might worry that this means they’re at an increased risk of prostate cancer, but this isn’t true. 

What is important is that the symptoms are checked to rule out prostate cancer, which affects one in eight men.

WHAT CAN I DO?

Orchid nurse Robert Cornes says: ‘Your GP should refer you to a consultant urologist.’ 

This appointment may require a rectal examination, and a blood test known as a PSA test which, although unreliable, can suggest whether cancer is more likely. 

Treatment for an enlarged prostate can include simple lifestyle changes, such as drinking less alcohol and caffeine, and exercising more. 

Medication can reduce the size of the prostate and relax the bladder, but in more serious cases – where drugs fail – surgery may be recommended. 

Even if the prostate is cancerous it might not need aggressive treatment as generally the tumours grow slowly.

THE INTIMATE INFECTION YOU SHOULDN’T IGNORE

Discharge from the penis, outside of sexual activity, is never normal. If you notice this, it’s probably the sign of an infection. The good news is such infections are very easy to treat, so don’t delay in seeing a doctor.

WHAT CAUSES IT?

White discharge indicates chlamydia, the most commonly diagnosed STI in the UK. It is passed on through unprotected sex, and mainly affects young people aged 15 to 24, but growing numbers of middle-aged men are being struck with it. It may be accompanied by pain when urinating or painful testicles.

Green discharge is a sign of gonorrhoea. It also causes inflammation of the foreskin and a burning sensation when urinating.

WHAT CAN I DO?

Both conditions are treated with antibiotics. Visit your local sexual health clinic to see a clinician and pick up a prescription. Alternatively, seek help from an online NHS sexual health clinic. They may offer you the option of a self-swab, which you can do at home and send off, as well as treatment remotely.

In the meantime, to avoid passing it on, don’t have unprotected sex as these infections can seriously affect a woman’s fertility.

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