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FAQs: Men's Health

What do you think of body waxing as a hair-removal process? Specifically, I had some hair on my back (I'm male) waxed "off" recently. It was an uncomfortable procedure, of course, but the redness is going down somewhat. Otherwise, I'm happy with the results. Is body waxing harmful? Thanks!

Body waxing seems to be a very reasonable way to remove body hair. For those who are not woolly enough to be in the know, body waxing is a popular way of removing unwanted body hair from legs, backs, faces, or elsewhere. Warm wax is applied to the furry areas, and then peeled off after it cools, pulling the hair out with it. It may be a little painful, but most people who have it done regularly do not seem to mind.

There do not seem to be any serious problems reported with body waxing. One letter in medical literature described a case of pseudomonas folliculitis -- that is, an infection of the hair follicles due to contaminated wax. But this seems to be very rare. There are a few precautions to keep in mind, however. Waxing should not be done on an area of skin where there is a rash. Also, if the person's skin is very thin and fragile, the skin may occasionally tear, or you may see a small amount of bruising. The redness you describe is to be expected, and I am told, usually goes away within a matter of hours.

-- R. Jandl,7/10/96, Category: general medical/men's health

I understand from a question concerning testicular examination in males between 20 and 34 that one should look for abnormalities such as enlargement or hardening of one testicle. Would having a varicocele on one testicle have the effect of enlarging the testicle over time?

A varicocele is a clump of dilated, or "varicose" veins that forms in the scrotum. It has the look and feel of "a bag of worms" -- a wonderfully descriptive though unattractive analogy.

All veins have valves in them that keep blood from going backwards, or down, due to the effects of gravity. Varicose veins occur when these valves do not work properly, and back pressure in the veins causes them to dilate. They are commonly found in the scrotum, and due to the anatomy of men's venous systems, occur on the left side about 97% of the time. A normal varicocele will be less prominent and softer when the man lies down because pressure within the veins is reduced. If this does not happen, make sure you get checked out to rule out an obstruction to venous flow.

Normally, varicoceles cause no problems. They do not cause enlargement of the testicle, although being near or adjacent to the testicle it may be hard to tell what part is testicle and what part varicocele. Infertility due to low sperm counts are a problem in some men with varicoceles. Removing the varicocele may increase the sperm count, but does not always restore fertility.

-- R. Jandl,5/29/96, Category: men's health

I'm a 29 year old male. After recently ending a year-long, very sexually satisfying relationship, I am dating once again. I am experiencing a problem, however, that when I sleep with someone I tend to lose my erection for a period of time in the middle of having sex. This usually occurs when I am focusing on doing something to or for my partner. These periods can last up to 15 minutes, even if I am turned on. While the erection always comes back, it is somewhat embarrassing, especially if the person I'm with thinks it's their fault. I have never had this problem before ... is this normal?
-- BK

Very normal. Most men experience some difficulty with erections at one time or another during their lives. It is also more common after divorce, the death of a spouse, or the end of any significant relationship. Impotence often generates anxiety, confusion, and frustration. A man will often wonder if he has lost his virility and may question whether it is temporary or permanent. The ability to enjoy sex through intercourse is often an important part of a man's sense of masculinity, and even self-worth. He may worry that his partner will lose interest, or become angry. And as soon as there is any doubt about whether or not an erection will be normal the next time, that doubt just increases the odds that trouble may persist. The partner is often affected too. There may be feelings of inadequacy, feelings of not being stimulating or desirable, or worries of not being liked/loved enough.

Troubles with erections may be relatively minor. There may be slowness in getting an erection, partial loss of the erection during intercourse, or inability to get a firm erection at any time. Sometimes, there is inability to get any kind of an erection at all, even a partial one. If none of the problems relating to medications, nerve function, circulation, or hormones are a factor, the cause is then said to be psychological. Interestingly, with psychological impotence, a man will usually have normal erections in the middle of the night, or upon awakening in the morning. Psychological factors may include such things as depression, or anger, resentment, hostility, or indifference towards the sexual partner. If there were ever a need to illustrate the power of mind/body interactions you'd be hard pressed to find a better example. Psychological impotence is at the root of about 50% of all causes of impotence.

Here are some general thoughts on psychological impotence. First, try not to worry about it. Of course that's easier said than done, but worrying only makes it worse. Try and brush it off as just a normal variation in a man's sexual activity. Try to stay relaxed about it. In most cases the impotence just goes away on its own. Also remember that sex is not, or at least ideally should not, be considered a performance. The jargon we all use, including words like potency, erections, penetration, sexual dysfunction, and achieving orgasm, all imply that this is an act of achievement or accomplishment. The emphasis would be better put on having fun, enjoying intimacy, and the great experience of being open, of sharing one's body, thoughts and feelings. How we think about these things, and the words we use, are important.

Think about reassuring your partner. If your desire is as strong as ever let her (or him) know. Taking the emphasis away from intercourse and orgasm may also help. Sometimes a period of sexual intimacy without the assumption or expectation of intercourse can defuse the situation. Experiment with new ways of sexual intimacy -- there may be some opportunities here. Be patient, and give yourself time. If things don't eventually get better, think about getting checked out by a doctor to make sure nothing is being over-looked.

-- R. Jandl,5/8/96, Category: men's health

I would like information about the procedure and short/long term after-effects of adult male circumcision.

Male circumcision, a procedure in which the foreskin of the penis is surgically removed, is occasionally done in adults. In newborn infants, the circumcision may be done by couples of the Jewish faith according to tradition on the eighth day of life, or often just to make Johnny "look like daddy." Having made it to adulthood with foreskin intact, circumcision is generally not done without a specific medical reason. For example, there is a condition called phimosis where there is progressive narrowing or tightening of the foreskin making erections painful and urination more difficult. Also, surgery may be recommended for recurrent yeast infections of the foreskin (especially in diabetics), and some cases of refractory warts involving the foreskin.

According to Dr. St. Clair, Tripod's consultant in urology, circumcision can be done in the office or at an outpatient facility. Local anesthesia injected into the foreskin, sometimes with a short-acting sedative, is used. The foreskin is then surgically trimmed back to the base of the glans, or tip, of the penis. Healing occurs rapidly over the next week or so. Complications are rare, but would include stenosis or narrowing of the opening to the urethra or urinary tube (less than a 1% risk), or an uncomfortable sensitivity of the glans lasting a month or two.

Having a normal foreskin as an adult is not a health hazard. Circumcision does not prevent later penile infection or cancer, and will not affect the risk of cervical cancer among sexual partners.

-- R. Jandl, 4/24/96, Category: men's health

I am considering getting a vasectomy, but I have heard stories of men experiencing prostate problems later in life. Is there any correlation of prostate problems with a vasectomy?
-- JS

The term "prostate problems" is pretty broad, but we can break it down into two major parts: Cancer of the prostate, and non-cancerous enlargement of the prostate. I am unaware of any links between vasectomy and non-malignant enlargement of the prostate gland.

With regard to possible links between vasectomy and an increased chance of developing prostate cancer later in life, there is a great deal of controversy. Several studies have suggested a relationship, but each of those studies, on subsequent review, was felt to have flaws in either data-gathering techniques or in statistical analysis which might invalidate the conclusions. The National Institutes of Health convened an expert panel to review the worldwide medical literature on this topic and in May 1993 their conclusion and recommendations included the statement:

"Because the results of research to date on vasectomy and prostate cancer are inconsistent, and the associations that have been found are weak, there is insufficient basis for recommending a change in clinical and public health practice a this time. Therefore, the panel recommends the following:

There have been other concerns raised about vasectomy, including the possibility of a connection with kidney stones, atherosclerosis (hardening of the arteries), testicular cancer, and an indescribable urge to hum the theme music from "Edward Scissorhands" while making love under a full moon in certain geographic locations. None of these has borne up under further scrutiny, although there is no saying what future research may reveal. In general, however, the risks of vasectomy are certainly less than the known risks of pregnancy and childbirth.

Vasectomy is almost always an office surgery, usually done under local anesthesia with sedation, and most men go back to work in two or three days. Complications such as bleeding, infection, and serious pain are uncommon (although they do happen.) Of the two permanent contraceptive procedures, vasectomies, overall, seem to lead to fewer and less serious short and long-term complications than do tubal ligations in women.

-- B. Kopynec, 2/18/96, Category: Men's Health

My husband is having trouble not coming very soon after we have started intercourse. He usually gets in five or six thrusts before he comes. What can we do?

The situation you describe is reported to affect, at one time or another, tens of millions of men in this country. It has no single underlying cause and is almost never associated with any specific disease. Masters and Johnson, nationally recognized experts on sexuality and sexual function, writing with Robert Kolodny M.D. in their book "Heterosexuality" describe a group of techniques that are frequently effective. Although these techniques are relatively simple, the descriptions are very specific and are accompanied by helpful diagrams, so rather than attempting to paraphrase them here, it would be most appropriate for me to refer you to a library or bookstore in order that you may review these recommendations for yourself.

One easy technique worth trying, however, is for you or your partner to squeeze the base of the penis tightly for several seconds, or until the feeling of impending ejaculation passes. This can be repeated as often as desired. Also, in many cases, a man's sexual activity is too often focused on the physical act of coming. There are many aspects to making love, and by spending time in a relaxed way, enjoying each other's bodies, talking, and being intimate in ways other than intercourse, the emphasis and pressure to come "at an appropriate time" is lessened, and premature ejaculation tends to improve.

I might add that there are two other remedies that couples may turn to in this situation. The first, is the use of topical anesthetic creams available over the counter which numb the sensation that the penis feels. However, this may lead to problems such as an allergic reaction to the chemicals. Also, as the cream rubs off on the woman's clitoris and vagina, her sensation may be diminished as well. A second technique, which has less in the way of side effects, is for your partner to wear a condom, or even two condoms, in order to decrease his stimulation. This may reduce his stimulation long enough for sex to be more satisfying for both of you.
-- B. Kopynec, 1/17/96, Category: men's health

When I masturbate or have sex I squeeze my penis just before ejaculation achieving climax without the mess. After joking with some friends, I found, to my surprise, I was alone in doing this. Am I harming anything by cutting it off, and where does the semen go? Incidentally, I do not have to squeeze hard and I do still feel the pulsations of ejaculation.

Semen is basically composed of two things: Sperm, and fluids from the seminal vesicles and prostate gland. At the time of ejaculation, semen travels from the seminal vesicles (where the sperm is stored), and prostate gland, into the urethra (the "urinary tube") and out the penis. If you think about it, as the semen enters the urinary tube, it could either go backwards up into the bladder, or forwards into the great outdoors. Your sexual organs figured this out a long time ago so that at the time of ejaculation, muscles located at the base of the bladder (just above the prostate) contract, preventing "retrograde" movement of the semen (and also, of course, preventing urination during sex!)

So, by completely blocking the urethra with your fingers, the pressure of the semen causes it to overcome that muscle at the base of the bladder, and the semen moves backward anyway. It does no harm there and will come out when you empty your bladder.
-- R. Jandl, 1/9/96, Category: men's health

I am on oral medication for diabetes and high blood pressure and have trouble getting an erection. What can be done about this?

Impotence, or "erectile dysfunction," is the inability to achieve a firm erection, or to maintain it long enough, for sexual intercourse. It is a common problem, affecting about 10% of men at any one point in time. About half the time it is caused by physical problems, the other half by psychological issues, and in many cases, of course, there are both physical and psychological issues.

As most men and women already know, erections occur for one of two reasons. The first is psychological, where erotic thoughts or feelings lead to sexual desire. The second is a reflex -- mediated from direct stimulation of the penis. For the psychological stimuli to work the spinal cord must be intact so that nerve messages from the brain reach the pelvic nerves required for an erection. In any case, however, the pelvic nerves must be working normally to get an erection.

The pelvic nerves will signal the arteries (bringing fresh blood to the penis) to dilate. This extra blood supply causes engorgement of tissues and an erection. In addition, in order to maintain an erection, the veins (carrying old blood away from the penis) are compressed by the expanding erectile tissue, helping to keep the penis engorged. So you can see that normally functioning arteries and veins are also required for an erection. Finally, the male hormone testosterone increases libido -- a deficiency of testosterone is another cause of impotence.

Although either psychological or physical problems can cause impotence, it is common for both to be present. And, of course, self-confidence tends to suffer when a man has had an episode or bout of impotence, further aggravating the problem. By psychological issues we mean, for example, tension, anger, or unhappiness in a relationship, sexual performance anxieties, and others.

In men such as yourself who have diabetes, there are many potential causes of impotence, some of which are more frequent than in the general population, such as nerve damage or poor circulation. Diabetics may also have other medical problems that require treatment with medication. And many medications may have impotence as a side-effect, the most common being anti-hypertensives, psychoactive drugs (anti-depressants and anti-psychotics), and some anti-ulcer medications. Other causes of impotence include cigarette smoking, which reduces blood supply to the penis, excess alcohol use by virtue of it's effects on hormones, some surgical procedures (such as prostate surgery in older men), other glandular problems, hardening of the arteries, spinal cord injuries, and others.

Patients having difficulty with erections should be assessed for whether or not the cause seems to be physical or psychological. Counseling can help the latter, and there are specialists in "sex therapy" who may be consulted. Sometimes, simply reassurance, and time, are all that is needed. If the cause is physical, it becomes important to look for easily reversible problems such as medications, or alcohol. If treatment is desired, choices include medications that help improve blood flow to the penis. And if those don't work, than an artificial means of erection would be the next option. These consist of either vacuum devices, or injection therapy using a medication injected directly into the penis. As a last resort, surgical placement of a prosthesis in the penis may be done.

How aggressive one is in using these approaches depends on how strong the desire is to resume intercourse. If impotence continues to be a concern, the first step would probably be to consult your regular physician. A specialist in urology, doctors who deal most extensively with impotence, could also be considered.
-- S. St. Clair, R. Jandl, 1/9/96, Category: men's health

I know that I should be doing a testiclar examination periodically. How often should this be done. How should it be done. What am I "feeling" for?

Testicular self-examination is the only practical way to screen for testicular cancer. As it turns out, testicular cancer is the most common malignancy of men between the ages of 20 and 34, with a life-long risk of one in 500 in American white males, somewhat less in African-Americans. Although testicular cancer is an aggressive, rapidly growing tumor, it is one of the success stories in cancer treatment -- today testicular cancer is about 95 percent curable.

To examine yourself, it is best to be in a relaxed, warm environment (where the testicles are fully descended and "relaxed") possibly in a warm bath or shower, or lying in bed. Hold each testicle between the thumb and two fingers of one hand, or between the fingers of two hands with one behind the testicle and the other in front of it. Roll the testicle softly between the fingers. With care, you will notice the scrotal contents: There is the normal ovoid testicle itself, and an elongated worm-like structure behind the testicle called the epididymis. (The epididymis carries sperm away from the testicle at the time of ejaculation.) Finally, as you move your fingers to the area above the testicle you will notice cord-like structures (which include the vas deferens -- for further sperm transport) and blood vessels.

Abnormalities to look for include enlargement or hardening of one testicle, or a hard mass or lump within or part of a testicle. Lumps found outside the testicle itself are usually in the epididymis and are most commonly benign, not cancerous. If you examine yourself regularly you will get to know what your normal testicles feel like. And if you do find a lump, get it checked right away, but be assured that most lumps turn out to be benign.

Interestingly, no studies have been done to prove that testicular self-examination actually finds cancers at an earlier stage, or increases the survival from treatment. Nonetheless, it is easy to do, harmless, and may well be of benefit. Self-examination is generally recommended once a month, from puberty on.
-- Stephen St. Clair, 11/24/95; Category: Men's Health

Is there any truth that zinc supplements can help men with a low sperm count? Many natural health related publications specify low amounts of zinc in the body as a key factor in male infertility.

The recommended dietary allowance for zinc is 15 mg/day for adult men. The average zinc content of the average American diet has been reported to range from 10-15 mg/day. Zinc is commonly available as a component of many multivitamin and mineral supplements. However, taking excessive amounts of zinc (>150 mg/day) could actually cause problems by interfering with your body's need for copper and iron.

Clinical zinc dietary deficiencies appear to be rare in the healthy adult population of the United States. However, alcohol abuse can produce zinc deficiency (and deficiencies in other essential nutrients as well).

Zinc serves many roles. It is important for normal growth and development as well as in male fertility. As an anecdote, one study published in the American Journal of Clinical Nutrition describes eleven male volunteers who demonstrated reduced semen volumes and testosterone concentrations when fed a special diet designed to be artificially deficient in zinc.

Therefore, although zinc seems to contribute to the maintenance of male fertility, the clinical significance is still not clear, and there is even some evidence that excessive zinc levels may impair fertility. Moreover, cases of clinically recognized zinc deficiency are associated with a variety of other symptoms and problems -- male infertility alone is not considered a hallmark of zinc deficiency, as other symptoms or problems are usually present as well.
-- L. Hill Einbinder, 10/26/95

Can too much caffeine affect the prostate. How? Can it raise PSA levels?

It is difficult to find any literature with direct reference to the effects of caffeine on the prostate gland. However, there is anecdotal experience that caffeine may indeed increase the frequency and severity of the symptoms of prostatitis (an infection of the prostate gland) or of "benign prostatic hypertrophy" (an enlargement of the gland in older men that is associated with symptoms such as difficulty passing urine and increased urinary frequency). The mechanism of this effect is not known. For men with prostatitis or hypertrophy, a trial of discontinuing caffeine is probably worth while.

Prostate Specific Antigen, or PSA, is a blood test occasionally used to screen for prostate cancer. It appears that PSA levels are unaffected by caffeine.

-- R. Jandl, 10/16/95

Has there been any success in finding a cure for Peyroni's Plaque?

Peyronie's Plaque, or Peyronie's disease, is a conditon whereby a fibrous plaque forms on the shaft of the penis causing curvature of the penis during erections. Early in the course, or if the curvature is severe, the erections may be painful. The cause is unknown. In some cases, the curvature is significant enough so as to prevent penetration during attempted intercourse. When the curvature is mild and sexual activity is unimpaired, then no treastment is generally indicated, although some Urologists will recommend vitamen E 400 IU/day. About one third of patients will spontaneously improve, and about a third will stay the same. In more severe cases, a variety of surgical procedures have been used to remove the fibrous plaque. The use of skin grafts after surgery to the affected area, laser treatments, and the weekly injection of a drug called nifedipine, have been reported sibly helping. The surgical procedures are imperfect as residual curvature or impotence may still result. Penile implants may be recommended in cases of irreversible impotence caused by Peyronie's disease.

-- R. Jandl, 10/20/95

What might be the cause of a single drop of bright red blood in semen?

There are rare occasions when blood can appear in the semen, and fortunately, even though it may be hard to pinpoint the cause, it is usually not a cause for concern. Usually it occurs in the absence of any other symptoms (like discharge from the penis, pain with ejaculation, trouble voiding, etc.). It is a symptom you should check out with your doctor, especially the first time it occurs, and especially if you have any of these other symptoms. He or she will check you for such things as tumors of the testicle or epididymus, and signs of infection.

-- R. Jandl, 10/12/95

My parents told me that all men, even if they feel well, should get a complete physical exam every year while they're in college. I feel great. Do I really need to do this?

For most healthy men, (let's assume you're between 16 and 30 years old), a routine complete physical exam every year is unneccessary. But there are a few things you should know or be aware of:

-- R. Jandl

I've been told that one of my testicles is undescended. There is only one in the sac. Is this going to hurt me in any way? I've had sex a few times and haven't noticed any problems.

Having an undescended testicle is fairly common. Some men feel a little insecure about it because they wonder if it means they will be less masculine. In fact, only one descended normally functioning testicle is required for normal secondary sexual characteristics (such as voice changes, hair growth, and physique), and for normal sexual drive and fertility. When, and if, the time comes, plenty of sperm will be made in order to conceive a child. So really, in terms of masculinity and sexual function there is nothing to be worried about.

You should be aware, however, of the increased risk of testicular cancer in the undescended testicle. There are no routine screening tests recommended for this. But as with all men, you should take a moment to check your testicle(s) for any new lumps every month or two.

-- R. Jandl

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