Mens Health Blog. Medical Blog

The six offenders vs. nieces were, at the time of offense, aged twenty-two, thirty-two, thirty-three, forty-five, fifty, and fifty-two. The niece of the eldest male was nearly thirty, but the nieces of the other males ranged from seven to fourteen. While not beyond what is generally considered (erroneously) “middle age,” these males were curiously ravaged by their years.1 In four of the six cases the interviewers felt obliged to comment on the discrepancy between seeming and actual age. The man who was thirty-two at the time of the offense was, at forty, described as “toothless, somewhat deteriorated”; the man of thirty-three (at offense and interview) was labeled “old!” by an interviewer more than a decade his senior; the forty-five-year-old (forty-seven at interview) was similarly called “old”; and the fifty-year-old (fifty-one at interview) was described as “too old—senile.”

This general picture of deterioration is paralleled by their mental status—not one was rated average or above. The youngest was feebleminded and the others were listed variously as “dull,” “low average,” “borderline,” and “inferior.” Like the offenders vs. sisters, these men were below par in sexual response to visual stimuli; four had little or no response.

The combination of young objects, subnormal mentality, and premature senility makes these men similar to the stereotype of the old, deteriorated child-molester. Indeed they fit the public image of the child-molester better than do the offenders vs. children.

Their heterosexual lives are, on the whole, not extraordinary, and all but two (one being the young man) ultimately married. Four had had some homosexual experience: for two it had at one time been of more than incidental significance, and perhaps this was also true of the feeble-minded young man.

As with the offenders vs. sisters, drunkenness was not an important factor, and neither were these men disposed toward additional sex offenses or other criminality. Of the six, only one man had an additional sex offense (one other man was convicted of multiple charges all stemming from one offense involving his niece). Nonsexual criminality was reported in three men: one violated some minor ordinances, another was convicted of loitering and assault and battery, and the third was incarcerated for what appears to have been petty larceny.

All in all, this group is very similar to the offenders vs. sisters: a mentally inferior group seeking sexual gratification, usually without force, from prepubescent or just-pubescent female relatives.

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NGU is transmitted through sexual contact with a partner who is infected: genital (penis to vagina), oral (penis to throat), or anal (penis to rectum). Men who perform anal sex may become infected with stool bacteria in the urethra. Correct use of a condom during sexual contact should be effective in preventing transmission of NGU, although condoms only decrease the risk of transmitting the herpes virus by about 50 percent (see the section on herpes). Condoms should be used for genital, oral, or anal intercourse with a partner who has not been tested, since a person can be infected but have no symptoms. Although many men believe otherwise, there is caused by allergic reactions, masturbation, too much caffeine, too little water, too much alcohol, spicy foods, or too much or too little sex.

TESTING FOR NONGONOCOCCAL URETHRITIS

To test for NGU, a urethral swab may be taken and examined for white blood cells. A small swab is inserted a short distance into the urethra (this may cause momentary discomfort). If examination under a microscope reveals a certain number of white cells, then the diagnosis of urethritis is made. If a man has urinated within the past four hours, the results may not be accurate, because the urine can wash away the signs of infection and the results would be falsely negative. For the urethral swab test to provide the most accurate results, the man should not urinate overnight before this examination.

If the results of the urethral swab test are negative but symptoms persist, the examination is usually repeated after the man has not urinated overnight. Alternatively, the man is instructed not to urinate overnight, and then the first part of the morning stream is examined under the microscope.

If a partner has been exposed to NGU in the throat or anal area, tests can be performed in these areas for specific organisms such as chlamydia and herpes virus, but not for all the bacterial organisms that can cause NGU, since some of them are difficult to culture.

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Both herpes simplex viruses are transmitted by skin contact with an area of a partner that is infected, or with secretions that are infected with the virus, such as semen, vaginal secretions, and saliva. The most vulnerable areas for acquiring herpes infections are mucosal surfaces, such as the mouth and throat, genital skin, or conjunctiva of the eye. Women acquire genital herpes more easily than men, probably because women have a larger area of mucosal skin surface in the genital area than men, which means that there is a larger area vulnerable to infection. Anywhere on the body where the skin is broken is also a vulnerable area.

Herpes is not transmitted through inanimate objects such as towels, drinking glasses, and toilet seats, but it can be transmitted through the use of shared sex toys, if they are immediately exchanged between partners. The virus is inactivated when secretions dry, and it doesn’t last long outside the body. (Theoretically, if someone with a genital lesion or oral lesion had direct contact with an object, such as a towel, which was then immediately put into contact with a vulnerable area of another person, such as the genitals, eyes, or mouth, then transmission could take place. But the likelihood of this actually happening is very remote, and there are no documented cases of herpes being transmitted in this way.) Herpes cannot be transmitted through the water or surfaces of a hot tub or a swimming pool. The only way to get herpes in a hot tub is to have sex with an infected partner in a hot tub.

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Infection of the prostate is evaluated by performing a rectal examination to feel the prostate and by evaluating fluid from the prostate under the microscope. This fluid can also be cultured to look for bacteria and other potential causes of prostatitis.

There is a stepwise progression in evaluating a man for a prostate infection. Usually a urethral swab is done first to evaluate for urethritis. The bladder is then emptied, and a midstream urine sample is collected for routine urinalysis to determine whether a bladder infection is present. (Bladder infections are relatively uncommon in men.) After that, a prostate examination is performed. This is best accomplished by doing a rectal examination. A gloved, lubricated finger is inserted into the rectum, allowing the prostate gland to be felt. A normal prostate gland is firm, without any irregularity in shape or tenderness to pressure. An infected prostate is tender, inflamed, and enlarged. Pressing on the prostate during the examination sometimes causes secretions to be released from the prostate; these secretions can be collected and examined under the microscope. Or after the examination the man can be instructed to urinate again (even though he had already emptied his bladder for the urinalysis), and this small amount of urine, which contains prostate secretions, can be examined under the microscope for infection and sent to the laboratory for culture to see if any bacteria are present. Bacteria in these prostate secretions indicate infection.

Some problems of the prostate are not caused by bacteria. Nonbacterial prostatitis is a condition in which the prostate is inflamed but cultured prostate secretions reveal no bacteria. Prostatodynia is a condition in which there are prostate symptoms but no infection is seen in the prostate secretions and no bacteria are seen on culture of this fluid. Both of these conditions are best managed by a urologist. Anxiety has also been shown to stimulate prostate inflammation and lead to symptoms that may mimic bacterial infection.

Other problems that may or may not produce these symptoms include the following:

1. Enlargement of the prostate, called benign prostatic hypertrophy, which is more common among older men.

2. Prostate cancer, which is also more common among older men

3. Stricture or scarring of the urethra.

4. An irritation of the pelvic muscles called pelvic floor tension myalgia, caused by sitting for prolonged periods of time.

5. Problems in the anal and rectal area, such as infection or constipation.

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Let’s say that you and your partner have discussed sex and your sexual health, and you are ready to begin an intimate relationship. What’s next? Unfortunately, talking doesn’t guarantee safety. For one thing, just because a person doesn’t have any symptoms of a sexually transmitted infection doesn’t necessarily mean that he or she is not infected (see Chapter 2 and Part II). Another consideration is that, even if you and your partner agree always to use a condom, you are not 100 percent safe: condoms sometimes fail because they are improperly used, and sometimes they break. Certain sexually transmitted infections, such as herpes and genital warts, can be transmitted even when condoms are used.

The bottom line is that the only way to know for sure whether or not you are infected with an STD is to be tested. If both you and your partner are properly tested at the time intervals at which any infection is likely to show up, and you are both negative for all infections, and you are both mutually faithful, then you may want to consider not using condoms for STD prevention. (See Chapter 5 for an explanation of the time intervals required to ensure accurate testing.) Under any other circumstances, you may want to assume that your partner may be infected with a sexually transmitted infection and therefore keep yourself safer by using condoms. If you or your partner has not been tested, or if you or your partner has other partners, then it is best to use condoms.

One important note: Because of the media attention devoted to HIV, many couples consider getting screened for HIV before becoming sexually involved, which is a great idea. Of all the sexually transmitted infections, this is the one of which most people are aware, and the one that most people are afraid of because it is life-threatening and incurable. Although testing for HIV is very important tor any sexually active adult, testing for HIV alone is not a complete screen for all of the sexually transmitted infections. (See Chapter 3 for a description of what is involved in a complete STD screening.) You may actually be at higher risk for acquiring other STDs (such as chlamydia or herpes) than HIV so it is important to get a complete screening.

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Several studies have suggested that men who smoke may be at a greater risk of developing prostate cancer. There is no solid evidence that proves this. For now, there seems to be only a weak association between smoking and prostate cancer. (One study, however, did suggest that men who smoke and are exposed to cadmium are at higher risk.) Having said this, it makes sense to add that smoking, which brings tobacco, nicotine (which is a powerful insecticide), and a host of toxic chemicals into every cell of the body—not just the lungs and throat—probably doesn’t decrease a man’s risk of getting prostate cancer. Conflicting reports have suggested that smoking may elevate hormone levels in men, and that this may somehow affect the prostate.

Anything Else?

Still other factors have been suspected, and studied, as potential risk factors for prostate cancer, including sexual behavior, viruses, socio-economic factors, other aspects of diet, and even BPH, but no strong proof has been found to link these elements to the disease.

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Should you be drinking alcohol every day? The question arises because research now conclusively shows that drinking moderate amounts of alcohol confers health benefits well into old age.

Evidence in support of alcohol’s beneficial effects is compelling: in middle and old age a small amount of alcohol reduces the risk of premature death. On the basis of this information alone, it seems logical that people older than about 40 should be advised to drink moderately. But the issue is not so simple.

Some doctors are concerned that if they encourage abstainers to drink and light drinkers to consume more, they will raise the general level of alcohol consumption in society and risk an individual cure becoming a community disease. The reasoning is that as more people drink, albeit moderately, hazardous drinkers will have more opportunity to drink and do themselves and others harm.

An Oxford study of 12 000 middle-aged and elderly British doctors over 13 years found mortality was lowest in those who averaged about two or three drinks a day. It is known that moderate drinking protects people from coronary heart disease. It achieves this in three ways. First, it increases levels of high-density lipoprotein (HDL) cholesterol (the ‘good’ cholesterol) in the blood, which inhibits the formation of plaque inside the artery walls. Second, it inhibits the formation of blood clots by making the little platelets of blood less sticky. Third, there is evidence that it stimulates the breakdown of clots.

Recent studies have also shown that modest alcohol consumption protects against the development of gallstones and can reduce blood pressure. However, high levels of drinking can increase blood pressure.

A man who has one or two drinks a day is at 30 to 50 per cent less risk of developing coronary heart disease than if he abstains totally.

So what advice do most doctors give? If their male patients are alcohol-dependent or have chronic physical, neurological or psychiatric disease related to alcohol, they advise them to abstain completely. Any beneficial effects of drinking would be more than negated by the damage they would continue to do to themselves. This group of men would also be unlikely to be able to keep their drinking to moderate levels.

If the men were not dependent but were in the habit of drinking to hazardous levels, and might or might not be beginning to experience some alcohol-related harm, they would be advised to reduce their intake to the safe levels recommended by Australia’s National Health and Medical Research Council. (The recommendation is that men drink no more than four drinks a day and women no more than two, and that both have at least two alcohol-free days a week.)

The issue is more complex when it comes to giving general advice. There is the question of age: as the incidence of coronary heart disease rises progressively over the age of 40, it would not be advisable to recommend that an 18-year-old start drinking.

But what about men in their 40s who presently don’t drink. Should they be advised to drink in moderation? Some doctors say yes. They give their patients all the facts, tell them that the peak protective effect is two drinks a day on average (for men) and then encourage them to consume that amount.

The problem is that these men may be inclined to drink more than that themselves and also encourage those already drinking four a day to increase their intake to six and start clocking up harm.

There are other ways of reducing the risk of coronary heart disease, such as exercising, stopping smoking, improving diet and taking aspirin.

On the surface, advising 40-something men to have a couple of drinks a day for the health benefit it confers seems simple and attractive. But it has attendant risks. Such men are twice as likely as women to suffer morbidity and mortality associated with alcohol consumption, so why exhort this high-risk group to drink? It’s difficult to lift moderate alcohol consumption without increasing immoderate consumption at the same time.

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Silling at home alone on a weekday morning when everyone else was at work, T.R. fell bereft. He was grieving for his old world. After 26 years at the same organisation he had been retrenched and his life had become unrecognisable. In a few weeks it had changed from that of a successful, frenetically busy supervisor to that of a man just sitting around at home.

As he sat there, it dawned on him that he was going through the same stages that people go through when they lose a loved one. In many ways, what he had lost was the equivalent of a relationship. He had lost his daily activity and the social interaction that went with it. A major source of his creativity and mastery was gone, he had no sense of purpose and the strong identity he had built within his job had vanished too.

His income had also gone. All through the rough economic times, when others had lost their jobs, he had kept his, believing all the time that he was indispensable.

At the age of 52 he was unprepared for the shock, disbelief and anger that often follow retrenchment. Even though his competence had never been questioned, he couldn’t help feeling he had failed himself and his family.

At the time my father silently worried about me. He had been through the Great Depression and knew what it was like to be out of work or to have it and then lose it. Now, in his 80s, he saw me suddenly in the same position. It took me some time to recognise the pain both he and my mother were experiencing.

T think it’s appropriate to talk about grief in the context of loss of work in mid-career. I was in despair and didn’t know what to do. I was lost.’

Throughout this period these lines from Dante’s Divine Comedy kept going though his mind: ‘Halfway along the path of life, I found myself in a wood so dark that the way ahead was lost to sight.’

For the next 6 months he languished at home, searching for a way through his grief, trying to make sense of what had happened. Then a friend offered him 4 hours a week lecturing at the local university.

‘Those 4 hours were just wonderful. They gave me back so much,’ he says. ‘They were the beginning of my rebuilding.’ The lecturing led to other bits and pieces and eventually to full-time work.

Despite having lodged more than 120 job applications during his dark period, he says every bit of work he got came through personal contacts and networks. He went on to work with mid-career men who were out of a job. He has found that following retrenchment, the first response is usually shock, because men always think it will happen to someone else. Then there is the pain of saying goodbye. These days, many middle-to-high-level managers are shown the door as soon as they are informed that they are to be retrenched and given little opportunity for farewells or occasions at which their long service or achievements can be publicly acknowledged. Others work on for a few weeks feeling increasingly alienated and unwanted. They see their names disappear from internal correspondence lists, hear colleagues making a claim for their desk or computer and are excluded from meetings of the new order.

The first few weeks at home can be unsettling. Everything is thrown up in the air and new roles and routines have to be negotiated. For the family it is a time of collective stress. In these situations there is often misunderstanding and conflict. Few think of preparing children for the consequences of a parent’s loss of work.

At home, the man’s sense of isolation can be heightened in many ways. Phone calls to former colleagues or professional contacts are often not returned and job applications not even acknowledged. The isolation can become intense. Some report that their day revolves around the mail delivery and the hope it will bring good news.

There is very little formal structure in place to help mid-career men cope with job loss. While there are numerous strategies for helping unemployed youth, the existence of this older group is barely recognised.

Even so, many can’t bring themselves to take advantage of the little that is offered and eventually only do so under pressure from their wives.

‘These men want to keep out of sight. They want to avoid social situations where they have to disclose their loss of employment. I call it the drawbridge syndrome – fill up the moat, raise the drawbridge and shut out the world.’

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While in poetic terms the eyes may be windows to the soul, in medical terms they are unique windows to health.

When eye specialists look into the back of an eye they see a microcosm of the person’s health. Not only do they see diseases that exist but they see evidence of diseases that are developing and have not yet declared themselves. One ophthalmologist recently found himself looking into the eyes of a man complaining of erratic vision. The man, a computer engineer in his early 50s, said his vision in one eye kept moving in and out of focus. It would be fine for a few minutes, become fuzzy for a few minutes and then become fine again.

At the back of his troubled eye the specialist saw a little lump of fatty material. It was the same material that usually accumulates on the walls of the large arteries in people with arterial disease. The lump had been swept off the carotid artery in his neck, travelled through his blood supply and lodged at the back of his eye.

Before he referred him to a vascular specialist, the ophthalmologist told the man how lucky he was. Had a bigger piece swept off and lodged itself in his brain, he could have had a stroke.

This man, who was at the peak of his career, presented with an eye problem but was spared a stroke that would have taken him out of the workforce and might even have killed him.

Nowhere else in the body are blood vessels so finely displayed as they are on the retina. It is like a showcase. Because of this, ophthalmologists regularly detect problems the patient is unaware of.

Among the conditions most commonly detected are high blood pressure, diabetes, hardening of the arteries, high cholesterol and various forms of inflammatory disease such as arthritis.

Despite the importance of vision and the value of having a medical eye examination, more than 50 per cent of Australian adults have never visited an ophthalmologist. Look at the case of a woman in her 30s who complained that when she read, the words slipped sideways. They were so mobile she couldn’t fuse them into the sentence.

When tested with the chart, her vision came in perfectly at 20/20. It was a different matter when her peripheral vision was tested. She had lost half the peripheral vision in each eye.

The symptoms were classic: she had a pituitary tumour in her brain that was compressing her optic nerves. Following surgery to remove the tumour, her previously excellent vision returned.

While the eyes provide windows to the rest of the body, they also contain within themselves signs of their own destruction. Ophthalmologists can see the beginnings of disease processes that will disable the eyes perhaps 30 years later. In many cases, these can be prevented or inhibited.

Most eye problems in Australia are associated with ageing.

The older people get, the more likely they are to have major conditions such as glaucoma, macular degeneration or cataracts.

The progression of the eye disease glaucoma illustrates the importance of prevention. It causes a build-up of excessive pressure in the eye, and by the time the person realises there is a problem, 90 per cent of the optic nerve is dead and the person is close to being blind. But doctors can pick it up easily, even in the very early stages, and provide eye drops to stop it.

Early detection can also inhibit macular degeneration, the leading cause of legal blindness in Australia. This condition results in the loss of central vision, but evidence that this loss will occur is apparent decades before the disease takes its toll. Smoking is a major risk factor for this condition, as is exposure to the sun’s ultraviolet (UV) rays. In some people laser surgery can help to inhibit macular degeneration.

Most people have surgery in their 70s for cataracts that began developing in their 40s. Again, smoking and UV exposure are risk factors. But so is diabetes. Eye specialists regularly pick up cases of undiagnosed late-onset diabetes when they come across patients with cataracts.

The fierce Australian sun is particularly effective in ravaging eyes. Over time, its high-energy UV rays can discolour the white of an eye, turning it an unattractive shade of yellow.

Its rays can also cause the formation of pterygium – unsightly masses of tissue that grow like clouds over the white of the eye and can obstruct vision. When sunlight damages the fine skin around the eye and causes a skin cancer, removing it can be a major job.

Skin cancers elsewhere in the body can usually be removed without causing much damage to the surrounding tissue. But around the eyes there is little in reserve. Removing a cancer from an eyelid without disturbing the function of the lid is difficult. The simplest way to protect eyes from the ravages of the sun is to wear dark glasses.

The one thing that can’t be protected against is floaters. By their late 30s people have begun to notice small dark spots or cobweb-like fragments appearing in their vision. These are called floaters and are fragments wobbling and moving in the gel inside the eye. They are caused by condensation of the gel.

When people look at the bright sky, the floaters appear as dark spots. When they suddenly turn their heads, floaters lag a bit behind but eventually appear in their field of vision almost like a piece of dust or a hair on a camera lens. Floaters are only a worry if they suddenly proliferate or are accompanied by (lashing lights. This could mean the gel is separating from the retina and emergency intervention may be needed. If you see flashing lights, you must get help.

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Women have been doing it for decades and now men are following suit. They are colouring their hair to camouflage the grey.

Small numbers of men have always dyed their hair, but now it is becoming a trend. Australian men are spending more than $6 million a year buying specially packaged men’s hair-colouring agents, and the figure is rising steadily.

Five years ago retail sales of men’s hair colour rose about 13 per cent, 3 years ago they were up another 17 per cent and last year sales grew a further 20 per cent. But men are actually spending more than this on hair colour. The figures do not include those men who buy female products or have their colouring done at a salon. The male market now even includes a range a colouring gels for beards and moustaches. (As yet there is nothing for eyebrows – men with grey eyebrows just have to live with them because colouring chemicals are not safe to use near eyes.)

This new trend is being fed by prime-time TV advertising and the industry hopes it will follow the male deodorant market. When male deodorants first came out, men were reluctant to use them. They thought it unmasculine. Now they are a common item in supermarkets. Until a few years ago, male hair colours could only be bought in pharmacies. Now they are in major supermarkets too.

These hair products are being bought by men of all ages, though the majority are aged 40 or more. Some perceive greying as a career disadvantage and others simply want to appear more youthful.

But despite the 5-minute treatments and the apparent ease and convenience of the procedure depicted in the advertisements, men who colour their hair are signing a pact with the devil. Once they start doing it, they’re locked in. The colour needs constant maintenance. If they stop they have to deal with a tidemark a line below which their natural hair colour begins to appear-which is an obvious sign to all that they have been busy with dyes. Once you start dyeing your hair, the only way to escape the colouring business is to wait for the artificially coloured hair to grow out and the natural hair to grow in.

Noel Hrannigan, who has been a hairdresser since his teens, learnt about hair colour the hard way. He had been grey for years, and for his 40lh birthday decided to use a subtle slate colour to lift his appearance.

He applied it and climbed into a hot bath to wait the 30 minutes it took to work. But he fell asleep. An hour later what he saw in the mirror was shocking. His thick, shoulder-length hair was solid jet-black.

His wife and children were aghast. They were already late for his birthday party and nothing could be done. Mr Brannigan didn’t want to go. When he walked in people laughed, thinking it was a huge joke and that he was wearing a wig to impersonate Roy Orbison. They even seated him at the piano.

‘I had to tolerate that colour for months until it grew out, and through that process I realised there are simpler ways of dealing with grey,’ he says. ‘One of the problems with chemical dyes is that they oxidise and throw an orange glow. Now when I walk into a well-lit room, it is quite obvious from the glow who has coloured hair.’

While halogen and fluorescent lights can be particularly unforgiving, he says the ‘Brylcreem’ look can help to tone down the orange because the oil deflects light.

The other problem is that chemical dyes irreversibly change the structure of the hair.

‘It’s like boiling an egg. Once hard-boiled, you can’t unboil it. Once a chemical agent has been used on the hair, the change can’t be washed out. It has to grow out,’ he says.

Instead of colouring the whole head of hair, Mr Brannigan streaks his male clients’ hair. He does this by strategically painting between 5 and 10 per cent of the hair so that the colour blends, looks natural and there is no risk of a tidemark if it is left for a few months. The damage to the structure of the hair is minimal and there is no obvious orange glow.

While men in the gay community are relatively open and easy about colouring their hair, he says others are often not. Typically, for male clients he opens his salon at 6 a.m. or 7 a.m., so they can be gone before the daily clientele drift in.

The difficulty for men is that, despite the booming retail sales, hair colouring is not yet completely acceptable. If a woman uses a product and gets the wrong colour, she can make a fuss. If a man gets the wrong colour he feels he has little recourse. It’s just too embarrassing.

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