MEN'S HEALTH MATTERS: Your health quesions answered
Q I read recently that the incidence of sexually transmitted infections (STIs) in males is increasing in Ireland despite the fact that people are now much more aware of the risks of unprotected sexual exposure. Is this true?
A With the ease and relative affordability of international travel, Ireland has seen a major rise in international health- related infections. International sexual health related diagnoses occur as a consequence of either population migration or increasing travel of Irish people. Implications include a wider spectrum of diseases being identified and the consequences of antimicrobial (drug) resistance for common pathogens.
High-risk sexual behaviour is increasingly common on such travels. Many travel destinations are to areas where HIV prevalence and genital ulcerative disease is high, which can lead to increased risk of HIV and other STDs.
Additionally as a consequence of economic success in recent years and a change in societal relationship structures (ie separation and divorce) many people engage in new relationships at a time in life when perception of sexual risk is perceived to be low.
Sexual health screening at one of the many clinics around the State should be undertaken post unprotected sexual exposure and periodically pending sexual health practices given that the majority of infections may not result in symptoms. Every man should self-exam the genital tract and testes at least once a month.
Most STIs are easy to diagnose and have effective and low-cost medical treatments.
Q Should all men be offered the opportunity to have their PSA checked?
A Routine screening of the population with PSA (prostate specific antigen - prostate blood test) cannot be recommended because it is not yet known if this test actually saves lives. Moreover, it is not clear if the benefits of PSA screening outweigh the risks of following up diagnostic tests and cancer treatments.
For example, the PSA test may detect small cancers that would never become life threatening. This situation, called over diagnosis, puts men at risk for complications from unnecessary treatment such as surgery or radiation.
We are waiting for the results of clinical trials from Europe and North America which will give us an answer to this very important question and until such time screening of the general population can not be recommended.
Doctors' recommendations for individual screening vary. Some encourage yearly screening for men over 50, and some advise men at a higher risk for prostate cancer to begin screening 40 or 45.
Several risk factors increase a man's chances of developing prostate cancer and these factors may be taken into consideration when a doctor recommends screening. Age is the most common risk factor, with nearly 65 per cent of prostate cancer cases occurring in men age 65 and older.
Other risk factors for prostate cancer includes family history, race and, possibly, diet. Men who have a father or brother with prostate cancer have a greater chance of developing prostate cancer.
African American men have the highest rate of prostate cancer, while Asian and Native American men have the lowest rates. In addition, there is some evidence that a diet higher in fat, especially animal fat, may increase the risk of prostate cancer.
Q I am 40 years of age and have been passing blood from my rectum for the past few months. I have minor constipation and have no pain. A friend told me that this is due to haemorrhoids - do I need to have this checked out?
A In a word, yes. Your friend is correct and the most likely cause is haemorrhoids. Haemorrhoids are a collection of dilated veins around the back passage and are caused by long-term difficulty with passing hard stools, which are common with a low fibre diet. In general they are very small and can cause occasional blood when passing a bowel motion or you may notice blood on the toilet tissue.
Over time they may become larger and protrude out through the back passage (prolapsed) and feel like a lump. Occasionally they may become acutely painful due to a collection of blood in this prolapsed haemorrhoid. In this instance some hospital treatment may be required.
Although haemorrhoids are the most likely cause in a man of your age it is important to rule out other conditions. This would entail an examination of your back passage. If haemorrhoids are found then they can be injected with a substance to cause them to become occluded and disappear with time. Minor rectal discomfort for approximately 48 hours is the only common side effect.
This column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with contributions from Dr Nap Keeling, consultant gastroenterologist and Dr Colm Bergin, consultant in infectious diseases.
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