Men's health is concerned with identifying, preventing, and treating conditions that are most common or specific to men.
Purpose
Men live on average seven years less than women; life expectancy in the United States is 72 years for men and 79 years for women. The reasons for this discrepancy are not completely understood. Men may have some genetic predisposition for lower life expectancy, as women tend to outlive men in most areas throughout the world. But men also have different lifestyle patterns that increase the wear and tear on their bodies. Studies have shown that men tend to drink and smoke more than women, men obtain medical care less frequently than women, and men generally have more stressful habits. It is clear to health professionals that men can benefit from increased knowledge of male medical issues and by understanding how lifestyle choices impact health.
Preventative practices for men's health emphasize diet, exercise and stress management, as well as the elimination of risky behaviors like smoking and excessive drinking. Four of the leading causes of death for American men are related to diet—heart disease, cancer, stroke, and diabetes. In addition men are more likely than women to suffer from diet-related conditions including high cholesterol, high blood pressure, and obesity, all of which increase the risk of certain diseases and premature death.
For American men, dietary problems are usually not the result of getting too little nourishment but of eating too much fat, sugar, and overall calories. The dietary change most likely to improve the health of males is reduced intake of fats, particularly cholesterol and saturated fats. Cholesterol and saturated fats are found mainly in meat and dairy products. Calories from fat should amount to no more than 30% of total daily calories. Eating adequate protein is generally not a problem for American men, so replacing some dairy and meat consumption with high fiber vegetable proteins such as beans and soy would be beneficial. Complex carbohydrates should provide the bulk of daily calories, such as those from whole grains and legumes, while sugar intake should be significantly reduced, such as in soft drinks, desserts and processed foods. Increasing dietary fiber is recommended by eating plenty of fresh fruits, vegetables, whole grains and legumes. Other principles of a healthy diet are avoiding artificial and processed foods, eating food that is as fresh and natural as possible, drinking plenty of water, and avoiding hydrogenated or partially hydrogenated oils, which contain unhealthy substances called trans-fatty acids. Overeating should be avoided as should snacking between meals, and alcohol intake should be limited to one or two glasses per day.
Exercise
The health of men has been affected as work patterns have shifted. Physical labor has been replaced by machines and office work. Studies have estimated that over 30% of Americans are now obese, which means that nearly one out of three people is significantly over-weight. Obesity poses many risks including increasing the chances of heart disease, diabetes, and some cancers. Effective exercise programs help men control weight, reduce stress, increase energy levels, improve self-esteem, reduce pain and injuries, and improve sleep. Exercise programs should emphasize flexibility and stretching as well as plenty of aerobic activities, such as running and swimming that exercise the heart and lungs and burn excess calories. Men may also choose anaerobic activities such as weight training to add muscles and increase strength. Routines should begin with warm-ups to reduce the chances of injuries and end with cool-down exercises to speedrecovery.
Stress reduction
Stress is a silent killer; chronic (long-term) stress is a risk factor in many of the major diseases affecting men's mortality rates. Prolonged stress may also cause ulcers, sleep disorders, addictions, depression, anxiety, and other conditions. Reduction of stress may require changes in both activities and attitudes. Exercise is recommended, as is reducing dependence on alcohol and nicotine. Men with extreme job-related stress may choose to spend more time with their families or in enjoyable activities. Men with stress levels that lead to destructive behaviors may need to pursue psychotherapy or significant lifestyle changes. Nutrition, social support, and healthy sleep patterns also reduce stress.
Alternative therapies may help with stress reduction. Their use has been adopted by many leading health centers. Biofeedback utilizes machines that monitor user's stress levels, so people can learn to control stress levels. Meditation and other mind/body techniques are taught to enable the relaxation response, which has the opposite effects of stress in the body.
Testing
Routine physical examinations performed by physicians are recommended every three years for men in their twenties and thirties, every two years for men in their forties, and every year for men over 50. Physicians may order several screening tests as well, depending on the age and condition of the patient. Blood tests screen for diabetes, high cholesterol, cancer, infections, and HIV. The prostate-specific antigen (PSA) test is a blood screen for prostate cancer. The digital rectal exam is used to manually check the prostate gland for enlargement or irregularities. Urine tests check for infections, kidney problems, and diabetes. The fecal occult blood test examines the stool for indications of ulcers or cancer. A sigmoidoscopy checks the health of the rectum and lower colon. Electrocardiograms (ECGs) check the status of the heart. Older men may consult an opthalmologist (eye specialist) every two years for vision and glaucoma testing.
Men may perform self-tests as preventative measures. During a skin cancer self-exam, the entire skin is checked closely for irregular or changing moles, lesions, or blemishes, usually red, white or blue in color. Abnormal findings should be reported to a physician. Like some forms of skin cancer, testicular cancer tends to spread rapidly and early detection is crucial. The testicular self-exam is best performed in the shower or bath, because warm water relaxes the scrotum. The testicles are gently rolled and massaged between the fingers and thumb to feel for bumps, swelling, tenderness, or irregularities. Some self-test kits are available in pharmacies, including ones for blood pressure, high cholesterol, colorectal cancer, and blood glucose tests for diabetes. These do not take the place of proper medical care, and physicians should be consulted before their use.
Heart disease
Heart disease is the major cause of death among men. It claims nearly half a million lives every year in the United States and is more likely in men than women. Heart disease can take several forms but the most prevalent is coronary heart disease, in which the blood vessels that supply the heart with oxygen become blocked and the heart muscle becomes increasingly stressed. Arteriosclerosis, a major factor, is the hardening of arteries due to the accumulation of fats and other substances. Hypertension, or high blood pressure also poses major risks for both heart disease and stroke. Angina pectoris is the chest pain associated with the early stages of heart disease; over three million American men suffer from it. When the blockage of blood supply to the heart becomes severe, a myocardial infarction (heart attack) may occur, which can be fatal.
The main symptom of angina pectoris is sharp pain on the left side of the chest that may radiate throughout the upper body. Other symptoms include shortness of breath, dizziness, fatigue, and swelling in the legs and ankles. Angina may be triggered by physical or emotional stress and lasts up to 30 minutes. Heart attacks have similar symptoms but with longer and more intense pain in the chest and upper body and may be accompanied by cold sweats and vomiting.
The American Heart Association lists the main risk factors for heart disease as being male, old age, having family history of the disease, smoking, high cholesterol, high blood pressure, diabetes, alcoholism, obesity, physical inactivity and stress. Clearly, lifestyle habits such as diet, exercise and stress control play major roles in the development and prevention of heart disease in men.
Cancer
The American Cancer Society (ACS) estimates that over 1.2 million cases of cancer were reported in 2000. Men have a slightly higher risk for cancer than women. The World Health Organization (WHO) estimates that the number of cancer cases in most countries will double in the next 25 years, while men's prostate cancer is expected to go up 40% worldwide. The most common cancers in men are skin, prostate, lung, colorectal (colon and rectum), lymphoma (lymph glands), oral (mouth and throat), and testicular cancer. The ACS lists seven warning signs of cancer:
Although the causes of cancer are incompletely understood, there are several risk factors that increase its chances: family history of cancer, smoking, poor diet (high in fat, low in fiber), excessive alcohol consumption, skin damage from sunlight, and exposure to radiation, chemicals, and environmental pollutants.
The prostate gland is a walnut-sized organ in the male reproductive system, located near the rectum below the bladder. The ACS reported that there were nearly 185,000 new cases of prostate cancer in 1998, causing 40,000 deaths, making prostate cancer the second most fatal cancer for men behind lung cancer. Worldwide studies have shown that about 12% of men in Western countries get prostate cancer, while 50% have enlarged prostates. Benign prostatic hyperplasia (BPH) is the enlargement of the prostate gland, called benign when it is non-cancerous although growth can be rapid.
With early detection, 98% of men with prostate cancer survive for five years. Many cases of prostate cancer grow so slowly that they don't require treatment. Symptoms of prostate cancer include difficulty in stopping or starting urination, frequent nighttime urination (nocturia), weak urine flow, and blood in the urine or semen.
Testicular cancer is most common in men between the ages of 15 and 34. The ACS estimated that there were 7,600 cases of testicular cancer in 1998.
Stroke
Strokes occur when the blood supply to the brain is interrupted and brain function becomes impaired due to lack of oxygen. Ischemic strokes occur due to blood vessels becoming blocked while hemorrhagic strokes are the result of broken blood vessels in or near the brain. Ischemic strokes account for about 80% of all strokes. The American Heart Association estimates that over 600,000 Americans suffer from strokes each year, with men having a 20% higher risk of stroke than women, although more women die from strokes. Other risk factors are hypertension (high blood pressure), previous heart attacks, age, family history, high cholesterol, smoking, obesity, alcoholism, and physical inactivity. African-Americans have 60 percent greater chances for strokes than whites.
Symptoms of stroke include sudden weakness or numbness, blurring or loss of vision, difficulty speaking or understanding, sudden severe headache, and dizziness or falling. Stroke victims should receive immediate emergency care.
Male urinary tract problems
The urinary system includes the kidneys and bladder, the ureters between the kidneys and bladder, and the urethra, the tube through which urine flows from the bladder. Symptoms of urinary tract problems include frequent urination, excessive urination at night, painful or burning urination, weak urination, blood in the urine, or incontinence (involuntary loss of urine). Urethritis is infection of the urethra, which is a major symptom of sexually transmitted diseases (STDs). Kidney stones (nephrolithiasis) are the most common urinary tract problems, accounting for nearly one out of every 100 hospital admissions in the United States. Eighty percent of kidney stone patients are men. About 12% of American men will develop kidney stones during their lifetimes. Kidney stones cause extreme pain when they move from the kidneys into the ureters. Ten percent of kidney stone cases require surgery. The best prevention for kidney stones is drinking plenty of fluids daily.
The male reproductive system
The male reproductive system includes the penis, testicles, scrotum, prostate and other organs. Problems include orchitis, or infection of the testicles, and hydrocele, the buildup of fluid on the testicles. Epididymitis is inflammation of the tube that transports sperm from the testicles, and can cause severe pain, swelling, and fever. A varicocele is a group of varicose veins in the scrotum that can cause swelling and damage sperm. Peyronie's disease is the abnormal curvature of the penis caused by accumulated scar tissue. Testicular torsion is considered a medical emergency, when a testicle becomes twisted and blood supply is cut off. This condition can lead to permanent damage if not treated quickly. It is most common in males between the ages of 12 and 18. Prostatitis is infection or inflammation of the prostate gland.
Sexually transmitted diseases include genital warts, chlamydia, gonorrhea, syphilis, genital herpes, hepatitis and HIV (human immunodeficiency virus). HIV is the leading cause for death for American men between the ages of 25 and 45. Symptoms of STDs include discharge of fluid from the penis; painful urination; sores, lesions, itching, or rashes in the genital area; and swelling of the lymph nodes in the groin. Prevention of STDs begins with safe sexual behavior: wearing condoms, limiting the number of sexual partners, not mixing sexual encounters with alcohol, and avoiding sexual contact with infected people, prostitutes and intravenous drug users. Men who engage in risky behaviors should have frequent HIV tests and medical examinations.
Male sexual health
Erectile dysfunction (ED), also called impotence,is a man's inability to maintain an erection for sexual intercourse. It is estimated that half of all men over 40 experience ED occasionally and 20 million American men are chronic sufferers, particularly older men as ED increases with age. Up to 80% of ED is caused by physical problems, while 20% of cases are psychogenic, or psychological in origin. Causes of ED include hormonal problems, injuries, nerve damage, diseases, infections, diabetes, stress, depression, anxiety, drug abuse and interactions with prescription drugs.
A self-test men can perform to determine whether ED is physical or psychological is the stamp test, or nocturnal penile tumescence test. Physically healthy men experience several prolonged erections during sleep. The stamp test is done by attaching a strip of stamps around the penis before bedtime; if the stamps are torn in the morning, it generally indicates that nocturnal (nightly) erections have occurred and thus ED is not physiological. Men with ED should see urologists for further diagnosis and discussion of the several treatment options available including drugs, hormone injections and surgical repair or implants.
Infertility occurs when men lack an adequate supply of sperm to cause pregnancy. As many as 15% of American couples are affected by infertility in one or both partners, or over five million Americans. A World Health Organization (WHO) project found that in about 20% of infertile couples, the problem was due to the man, while in another 27% of couples both partners had infertility problems. Injuries, birth defects, infections, environmental pollutants, chronic stress, drug abuse and hormonal problems may account for male infertility, while one in four cases has no apparent cause and is termed idiopathic infertility. Declining sperm counts have been observed in industrialized countries, and possible explanations for this decrease are as diverse as increased environmental pollutants to the use of plastic diapers, which a German study claims damages infant testicles by keeping in excess heat. Male infertility can be diagnosed by sperm analysis, blood tests, radiographic scans of the testicles and other tests.
Other types of sexual dysfunction include premature ejaculation, in which men cannot sustain intercourse long enough to bring their partners to climax, and retarded ejaculation (also called male orgasmic disorder) when male orgasm becomes difficult. Some men have periods of inadequate sexual desire (hypoactive sexual desire disorder), while sexual aversion disorder (SAD) is fear and repulsion of sexual activity. Dyspareunia is painful intercourse, and should be reported to physicians as it may indicate STDs or infections. In addition to medical care, sexual dysfunction may be treated by sex therapy or psychotherapy depending on its causes.
Vasectomies, a form of male birth control, are surgical operations that sever the tubes that transport sperm from the testicles. Vasectomies can be reversed but ten percent of men become infertile due to the surgery. Circumcision is the surgical removal of the foreskin of the penis, for religious and medical reasons, performed on 60% of newborn males in the United States. Increasing controversy surrounds this procedure. Advocates of circumcision claim it prevents infections (called balanitis) on the head of the penis and reduces chances of penile cancer. Opponents of circumcision claim that the outdated procedure affords no medical benefits, that it causes unnecessary pain for infants, and that the lack of a fore-skin may reduce sexual pleasure and performance.
Men's emotional health
Depression is a mood disorder marked by sadness, emotional pain, and the inability to feel pleasure. At least 10% of men will experience an episode of major depression at least once in their lives. Men with depression are five times more likely to commitsuicide, a major cause of mortality in men. Men are half as likely to seek psychological help than women. Men may suffer depression and emotional problems between the ages of 50 and 65, called the midlife crisis as men face the major transition into retirement and older age.
Panic attacks have symptoms of overwhelming fear, chest pain, shortness of breath, numbness, and increased heart rate. Men may mistake them as heart attacks. Men are also plagued by addictions to nicotine, alcohol, and other drugs, which are often the unhealthy escape routes from deeper emotional issues. Studies have estimated that as many as one third of Americans have suffered from sleep disorders, which may be psychological in origin and related to anxiety, stress and lifestyle.
Mental illness can be particularly difficult for men because in our society men are taught to withhold rather than express emotions and feelings. Emotional problems can be strong signals for men to communicate and confront deeper issues. Help can be found from physicians, psychotherapists, and spiritual or religious counselors.
BOOKS
Bauman, Alisa, Brian Kaufman, and Men's Health Books, eds. Symptom Solver: Understanding and Treating the Most Common Male Health Concerns. Emmaus, PA: Rodale, 1997.
Inlander, Charles, and the People's Medical Society, eds. The People's Medical Society Men's Health and Wellness Encylopedia. New York: Macmillan, 1998.
Weil, Andrew, M.D. Natural Health, Natural Medicine: A Comprehensive Manual for Wellness and Self-Care. Boston: Houghton Mifflin, 1998.
ORGANIZATIONS
American Foundation for Urologic Disease. 1128 N. Charles St., Baltimore, MD 21201. (401) 468-1800. <http://www.afud.org>.
Center for Holistic Urology. 161 Fort Washington Ave., New York, NY 10032. (212) 305-0347. <http://www.holisticurology.com>.
OTHER
A Man's Life Online Magazine. <http://www.manslife.com>.
The Prostate Cancer Infolink. <http://www.comed.com/prostate>.
Douglas Dupler, MA
KEY TERMS
Emphysema—Disease of severe lung deterioration and impairment.
Obesity—Condition defined as being overweight by 30 percent of normal limits.
Sigmoidoscopy—Test procedure using an optical instrument to view the internal rectum and colon.
Urologist—Physician specializing in male reproductive and urinary systems.
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