mens health

Scrotal Gangrene: Adventures in Medical Journalism

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I’ve been talking about scrotal gangrene a lot lately.

Be it a casual conversation with co-workers, a date, or a telephone call with my mom; I have somehow managed to sprinkle scrotal gangrene into almost every social interaction (in hindsight, perhaps I should apologize for this).

I’ll explain. I’m a health journalist. During the day I edit and produce news pieces, women’s health, digestive health, thyroid health and columns written by patients and doctors. Outside of my day job, I run a support organization for women with endometriosis. My typical day consists of talking about uncomfortable medical topics and then going home and talking about (or writing about, etc…) menstruation.  Needless to say, if we were to play the penis game (the game where the person who can yell penis the loudest, wins) — I would win.

Sometimes, I have some extra free-time in which I freelance as a technical medical writer. When I started writing, I was asked what my specialty was — to which, naturally, I replied ‘women’s health.’  So you can imagine my surprise when I was assigned a piece on Fournier gangrene (aka scrotal gangrene).

Based on the amount of research I did for that piece,  I am fairly confident that I could (should the occasion ever arise) identify scrotal gangrene. Scratch that — based on the number of necrotizing penises, scrotums and perineums that ambushed my computer screen, I am fairly certain I could diagnose scrotal gangrene as unfortunately, those images are not something easily forgotten.

How does one get scrotal gangrene you ask?  In order for gangrene to occur in the genitourinary or anorectal region you need several different types of bacteria to intermingle somewhere around an open wound, rash, burn or any sort of opening in which bacteria could fester. The most common type of bacteria found in Fournier gangrene cultures is E.coli (which is also found in the digestive tract and in feces).

When this bacteria combo makes its way into the body it can cause fever and edema (a type of swelling) in the affected areas. In a matter of hours the skin can begin to necrotize and if not caught quickly, can lead to excess debridement (the shaving off of layers of skin), organ amputation, sepsis and death.  Fortunately, Fournier gangrene is incredibly rare and even rarer in women (who can get perineal and vulvar gangrene).

When scrotal gangrene does occur it usually occurs in older people and people with compromised immune systems.  Although… There was this one case; regarding a 29 year old male, who masturbated so frequently that he had friction burns. Guess what happened to the friction burns — they got infected, and he developed Fournier gangrene on his penis. He survived but I can’t imagine the procedure to remove the necrotizing skin was all too pleasant.

And that my friends, is why I got into health journalism; so I could teach the world about the importance of personal hygiene. Just kidding… It was to have fun facts to make people feel uncomfortable at parties.

Lazy Men Have Fewer and Slower Sperm

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Two publications from the same the study population (Rochester Young Men’s Study) affirmed what women everywhere have long suspected: active, healthy men make better mates. That’s right, exercise and healthy diet affect a man’s ability to mate at the most fundamental level – his sperm quality.

Researchers from Harvard’s School of Public Health found that otherwise health young men (ages 18-22, n = 188) who were predominantly sedentary and/or eat poorly had significantly fewer sperm and slower, less active sperm. Because the studies were analyzed and published separately and we were only able to access the abstracts, it is not clear if men who were both sedentary and had a poor diet suffered greater reductions in sperm quantity and quality than men who met only one of those requirements. We can only surmise that it would be the case.

Physical activity and sperm quantity. Men with greater than 15 hours per week of moderate to vigorous activity had an average 73% more sperm than men who were largely sedentary and exercised <5 hours per week.

Diet and sperm quality. Men who ate well and included fruits, vegetables and fish in their diets had 11% more active (motile) sperm than men who ate the typical western diet rich in processed food and red meat.

The takeaway, exercise and healthy diet impact one’s ability to conceive at the most basic level. So before mating or seeking pricey fertility treatments, consider cleaning up your diet and lifestyle.

Much Ado: Reduced Penis Size Post Prostate Cancer Treatment

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Prostate cancer is the most common cancer among men in the US. It is second only to lung cancer in causing death. As of 2009, the most recent CDC stats reported, over 200,000 men are diagnosed annually and almost 30,000 die. Prostate cancer is a disease of older men with over 65% of those diagnosed over the age of 65. In men under the age of 40, the rate of diagnosis is 1 in 10,000 compared to 1 in 15 for men between the ages of 60-69.

Even though prostate cancer is the most common cancer among men, it is the most survivable with 91% of the men living 10 years post diagnosis. Because of its high survival rate, the quality of life post diagnosis and treatment is of great concern. Depending upon the treatment selected, post treatment side effects include:

  • Urinary, bowel and erectile dysfunction
  • Infertility
  • Hormone and chemo side effects

A new study published in the journal Urology found that some men report slightly shorter penises post prostrate cancer treatment – a side-effect that they were none too pleased about. The study looked at complaints of reduced penis size in 948 men with recurrent prostate cancer. Results showed that only 2.63% (25) men reported a perceived reduction of less than 1/2 inch. Penis size was not measured pre- or post- treatment. In fact the study was conducted retrospectively – 5 years post treatment. Nevertheless, the authors and editors thought this worthy of publication.

According to the study’s lead author, Paul L. Nguyen, M.D., a radiation oncologist at Dana-Farber Cancer Institute and Brigham and Women’s Cancer Center in Boston:

“Some people might think this is frivolous — who cares about a slightly shortened penis — but it really does affect people’s lives,” he said in an interview. “If guys [in the study] had this bad result they were much more likely to regret the path they chose. This is important to talk about up front when people are making their decisions.”

Certainly, if in fact this was an actual, measurable side-effect of prostate cancer treatment, then men should be apprised of its possibility. Since the study was retrospective, no measurements were taken and the study was conducted entirely in a population of older men where age-related shrinkage is just as likely as treatment related shrinkage, it is difficult to determine what, if any effect, treatment had on actual penis size.

Even if there was measurable, though minute shrinkage, it seems like this may be the least of one’s worries when facing prostate cancer. Perhaps, we should be spending more time on mitigating the more severe treatment side-effects, or better yet, preventing prostate cancer altogether. Finally, why was this study published at all?

Exercise, Ibuprofen and Your Gut

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Ibuprofen and NSAIDs of other brands are used frequently by athletes around the world. Commonly referred to as Vitamin I, many athletes believe ibuprofen improves performance by extending the duration of pain free training or competition, despite evidence to the contrary.

A recent flurry of studies on male athletes indicates exercise induces a type of gut injury commonly seen in patients post surgery called splanchnic hypoperfusion or inadequate blood flow to the gut, kidney and liver. The abdominal distress common with intense training or competition, is really a state of reduced blood flow to the gut. The reduction in blood flow makes sense given the biological predilection to funnel energy away from digestion and metabolism during periods of fight or flight, even those that are self-induced.

GI hypoperfusion causes all sorts of mostly minor injuries, including general GI dysfunction, increased inflammation, increased permeability of endotoxins, but also, can cause more severe ischemic events – the complete cessation of blood flow to a particular abdominal region.  Repeated periods of hypoperfusion may cause more damage.

To counter the pain associated with GI hypoperfusion and training in general, athletes often self-dose with ibuprofen. Research indicates that ibuprofen increases the GI damage and does not improve performance. In fact, ibuprofen users often experience more pain, abdominal and otherwise, and perform more poorly.

Consistently, the research on ibuprofen use by athletes is conducted with male athletes. What about about female athletes? More specifically, how does regular, though cyclical, often high dose ibuprofen use to relieve menstrual pain, affect GI function and athletic performance in female athletes? Are female athletes more susceptible to splanchnic hypoperfusion and the ensuing endotoxemia? Does the use of ibuprofen worsen the abdominal injury or perhaps even worsen the menstrual pain as time passes? Research on pain tolerance suggests that ibuprofen does not work at all for many women, despite the fact that women are the largest users of ibuprofen for a range of predominantly female conditions. Similarly, research on analgesic response across the menstrual cycle demonstrates clear cycle-related changes in analgesic effectiveness. Given the high usage rates of ibuprofen in women, especially athletic women, it would seem relevant to investigate gender differences in ibuprofen effectiveness and gut damage.

If you have research on these topics, please send them to us. We’d like to know and our readers would like to know.

Photo: by Dirk Hansen (Flickr) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

 

 

Marines, Male Breast Cancer and Environmental Toxins

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Male breast cancer is rare. It accounts for less than one percent of all new cases and only about 2100 men are diagnosed annually. This is compared to ~288,000 women who diagnosed with breast cancer in 2011. Perhaps because it is so rare, male breast cancer does not receive the attention it deserves. That may change. A cluster male breast cancer patients, marines from Camp LeJeune, is bringing attention to this oft forgotten disease and may help re-frame the role of environmental toxins in all breast cancers.

Environmental Exposure and Breast Cancer

The American Cancer Society attributes only 6% of all cancers to environmental toxins. In contrast, a report by the President’s Council on Cancer, published in 2010 suggests that the connection between environmental toxins and cancer is grossly underestimated. The report points to the 80,000 unregulated chemicals on the market today that have either never been studied at all or have been studied only minimally. The report indicates that our understanding of environmental and occupational hazards is limited at best.

Increased Environmental Exposure and Higher Breast Cancer Among Troops

Young (25-35 year old) female military members are 20-40% more likely to develop breast cancer than their civilian counterparts. According to the Armed Forces Health Surveillance Center from 2001-2011:

  • 800 women were injured on duty in Iraq and Afghanistan
  • 874 were diagnosed with breast cancer

Researchers speculate that the chemical toxins common in the military are to blame, but data are limited and funding for additional research has stalled in Congress.

Enter a group of scrappy, angry, male marines diagnosed with breast cancer from Camp LeJeune. Reported in Mother Jones, these male breast cancer survivors are fighting and winning the battle to connect breast cancer to environmental toxins.

Over the last several decades, marines and residents of Camp LeJeune were exposed to a chemical cocktail in the water supply Higher rates of leukemia, birth defects and a bevy of other cancers have been observed.  More interestingly, 80 men from Camp LeJeune have been diagnosed with breast cancer. Researchers speculate that the high incidence of male breast cancer observed at Camp LeJeune may provide the clearest evidence to date connecting environmental toxins to breast cancer, male or female. Large scale, case control studies are underway, with data expected in 2014. Until then, we are left to wait and worry.

To learn more about the grass-roots efforts that led to the cancer studies, join a discussion board and/or register a disease, see:

 

Male Birth Control – Myth or Available Science?

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I’ve never been able to take hormonal birth control. I have tried and the side effects were so extreme that I almost ended up in the ER more than once. After telling each new doctor my past horror stories, they would each reassure me that I simply had the wrong doses and had to try a different brand. I tried three times in my adult life and every single time was a disaster that seemed to progress from the last. So, I gave up on hormonal birth control.

Most women I know have been on birth control most of their adult life, some even since they were teenagers. While I always tell myself that there might be long-term side effects outside of the ‘clinical trial’ time frames (not that I wish bad health on anyone, but would be my top concern if I was on any medication long term), most women are happy poppin the pill (or now the other various forms of hormonal birth control like IUD, rings, patches, etc). Furthermore, most men are happy letting their lady take on that responsibility.

For the most part, I’m okay not being on a hormonal birth control. It is awkward when dating someone and getting to that point where things might lead to more than just dinner a movie and I have to bring up that little, unpleasant fact, but otherwise I’m happy with my natural mood swings and erratic hormones.

I’ve been with my boyfriend for over 3 years now, so I haven’t had to have “the talk” recently. However, back in my dating days, I was always shocked at how shocked men were that I wasn’t on the pill. It was like the idea of a woman not being on some form of birth control was absurd to them. What I love about Brent (well, I love a lot of things about him) is that after witnessing the extreme effects of hormonal birth control in my body first hand, he has accepted that we have to take other measures to prevent pregnancy. He’s also assured me that if a male birth control comes available he would be willing to try, but only after many clinical trials and a year or two of being on the market (I can’t blame him with the controversial drugs the FDA has approved in the past).

Male Birth Control

Turns out there are forms of male birth control. Quite a few actually and very few of them are hormonal, which would have the most risk and side effects. Some sound weird, and lots are still in clinical trials (And there is no way in hell we would even consider a clinical trial – can you imagine being in the placebo group?!). Let’s look at some of the new forms of birth control that share the reproductive responsibility.

It is important to remember that, like female contraceptives, these treatments do NOT protect against sexually transmitted diseases.

RISUG

In India, they have developed a long-term, reversible solution that is 100% effective in clinical trials. The Reversible Inhibition of Sperm Under Guidance or RISUG might be a good option if your man doesn’t mind needles. According to Techcitement the simple procedure is as follows: “A doctor applies some local anesthetic, makes a small pinhole in the base of the scrotum, reaches in with a pair of very thin forceps, and pulls out the small white vas deferens tube. Then, the doctor injects the polymer gel (called Vasalgel here in the US), pushes the vas deferens back inside, repeats the process for the other vas deferens, puts a Band-Aid over the small hole, and the man is on his way. If this all sounds incredibly simple and inexpensive, that’s because it is.” How does it work? “The two common chemicals – styrene maleic anhydride and dimethyl sulfoxide – form a polymer that thickens over the next 72 hours, much like a pliable epoxy, but the purpose of these chemicals isn’t to harden and block the vas deferens. Instead, the polymer lines the wall of the vas deferens and allows sperm to flow freely down the middle (this prevents any pressure buildup), and because of the polymer’s pattern of negative/positive polarization, the sperm are torn apart through the polyelectrolytic effect.” Another benefit, RISUG does not cause the common side effects of a vasectomy: granulomas and an autoimmune response.

Will it be approved? It has yet to get approval in India, and, according to Science Based Medicine, trials on rabbits are just starting in the US (published May 2012). Perhaps this birth control is just too good to be true and pharmaceutical companies stand to loose too much if men have to get a shot once every ten years and without side effects, are 100% reversibly infertile.

What’s more – this treatment might actually prevent HIV transmission from male to female during intercourse.

Male Hormonal Birth Control

In Denmark, studies are being conducted in hormonal birth controls that rather than taking a pill daily (because men can’t bother with that?), tiny rods are inserted under the skin of the arm that deliver the hormones. These rods deliver etongestral, a progesterone often used in female birth control pills. The etongestral blocks sperm production and is considered reversible. The downside: to block sperm production, it blocks testosterone production as well. Participants of the study have to get testosterone replacement therapy injections every 4-6 weeks to maintain their sex drive, as well as their male characteristics. If approved, patients would only have to change the rods every three years.

There are other hormonal birth controls on trial. Some involve topically applied gels, others pills, or shots every few months; but they all work the same and have the same side effect of blocking testosterone production in the testes.

Other Odd ‘n’ Ends

There are surprisingly lots of clinical trials and products out there for male birth control. And maybe not-so-surprisingly, those that were not hormonal had very few side effects. I suppose it makes sense that it would be easier to control men’s sperm that are located externally, opposed to internally manipulating our eggs.

Suspensories, a pair of brief-like garments holds the testes closer to the body, raising the temperature of the testes and suppressing sperm count and making the remaining sperm poor swimmers. Here are other heat treatments.

Intra Vas Device (IVD), is a set of implants that block the flow of sperm. According to malecontraceptives.org, “These tiny, pre-formed, flexible silicone plugs are inserted into the vasa deferentia, the tubes carrying sperm from the testes. The device is sized to the width of each recipient’s vas deferens, filling the lumen (the opening in the vas tube) but not stretching the tube. Two plugs are inserted in the same vas with a small space between them. If sperm pass around the first plug and enter the space between the two plugs, the second plug blocks them. In order to prevent the plugs from moving within the vas deferens, they are anchored with small sutures to the wall of the vas deferens itself. Once implanted, they can not be felt. The IVD is similar in function to a vasectomy, but it leaves the vasa deferentia intact.”

Hopefully these new forms of birth control will soon be on the market and women like me, who can’t or choose not to, take hormonal birth control will be able to share the responsibilities of reproduction. All I can say is it’s about damn time!

For more information on clinical trials and other treatments check out MaleContraceptives.Org, it had the most inclusive, detailed and reliable information I could find on the subject.