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Men’s Health: Common Conditions Men Worry About

Men’s Health: Common Conditions Men Worry About | UPMC Italy

Various studies have shown that women are more attentive to health and prevention compared to the male population, adopting healthy lifestyles and regularly undergoing screening exams and specialist visits. What are the most common male health disorders that men struggle to seek medical advice for, often due to embarrassment?

Erectile Dysfunction

Erectile dysfunction (ED) is the most common sexual problem among men, affecting about 30 million worldwide. It occurs when a man has difficulty achieving or maintaining an erection and is very common in men over 40 but can also manifest frequently in younger individuals. In Italy, about 13% of the adult male population (1 in 8 men) is affected, involving over 3.5 million people (ISS data, 2023). In 2023, sales of medications to treat erectile dysfunction exceeded 200 million euros (AIFA data), placing us second in the world, after the UK.

In most cases, erectile dysfunction is linked to underlying clinical conditions, such as:

  • High cholesterol.
  • Uncontrolled hypertension.
  • Diabetes (those affected are three times more likely to develop ED, as high blood sugar levels damage the nerves and blood vessels responsible for erection).
  • Obesity.
  • Neurological disorders.
  • Spinal cord injuries.

In other cases, ED has psychological origins and is often related to factors like anxiety, stress, or depression. Lifestyle also has a significant impact: smoking and excessive alcohol consumption can negatively affect erectile function.

ED can also be an indicator of more serious health issues. For this reason, it is important for any man experiencing it to consider it a warning sign and consult a specialist for a thorough evaluation.

Treatments for ED may include oral medications that relax muscles and increase blood flow to the penis during sexual activity, thus improving the ability to achieve and maintain an erection.

Premature and Delayed Ejaculation

Premature ejaculation (PE) occurs when ejaculation happens sooner than desired during sexual activity. According to data from the Italian Society of Andrology (SIA), PE affects about 25% of the Italian male population between the ages of 18 and 60.

Although the precise causes are not entirely known, various factors can contribute to the development of this disorder:

  • Low serotonin levels: An insufficient amount of this chemical produced by nerves can lead to quicker ejaculation.
  • Age: As men age, the duration of erection before ejaculation may decrease.
  • Psychological factors: Stress, anxiety, and depression can influence the onset of PE.

Several treatment options for PE exist:

  • Topical agents, such as anesthetic creams or sprays, which reduce sensitivity and have few side effects.
  • Oral medications, which must be prescribed and monitored by a doctor.
  • Behavioral therapies that help improve control during intercourse.

Delayed ejaculation, on the other hand, occurs when ejaculation happens with difficulty or after more than 30-45 minutes from the start of sexual intercourse. Causes can be psychological, such as past trauma, or physical, including:

  • Obstruction of the ejaculatory ducts.
  • Nerve damage in the pelvic area.
  • Neurological conditions, such as stroke or spinal nerve injuries.
  • Use of certain medications.

Treatments for delayed ejaculation may include:

  • Specific medications.
  • Review of ongoing medication therapy for other conditions.
  • Psychological support, possibly aimed at treating substance abuse issues such as alcohol or drugs.

Low Testosterone

Testosterone is the male sex hormone produced in the testicles, crucial for sperm production. During puberty, it is responsible for the growth of body and facial hair, voice changes, and muscle mass development. When testosterone levels are low, symptoms can include:

  • Depression.
  • Erectile dysfunction.
  • Fatigue.
  • Irritability.
  • Reduced sex drive.
  • Loss of lean muscle mass.

A simple blood test can detect low testosterone levels. In these cases, the first recommended step is weight loss and increased physical activity. If these measures are insufficient, testosterone replacement therapy may be necessary, available in various forms:

  • Intranasal, with gel applied to the nostrils.
  • Topical via gels, creams, liquids, or patches.
  • Injections, which can be weekly, biweekly, or monthly.
  • Subcutaneous pellets that release testosterone gradually.

The use of testosterone must always be evaluated and monitored by a specialist. Self-administration without medical supervision is strongly discouraged, as improper use can lead to serious complications and health issues.

Infertility

In Italy, about 15% of couples face infertility issues, with the male partner being the cause in 50% of cases (source ISS, 2023). The main causes of male infertility include:

  • Absence of ducts in the reproductive systems.
  • Age-related factors, such as reduced quantity and quality of sperm, genetic abnormalities in sperm, erectile dysfunction, and changes in reproductive organs (e.g., prostate enlargement, which can hinder ejaculation).
  • Hormonal imbalances or blockages preventing normal sperm production.
  • Lifestyle factors, including diet, weight, physical activity, stress, exposure to environmental or occupational factors, and drug and medication use.
  • Testicular problems that compromise sperm production.

If pregnancy has not been achieved after one year of unprotected sexual intercourse, it is important to consult a specialist.

Peyronie’s Disease

Also known as penile curvature, Peyronie's disease is characterized by the formation of scar tissue (plaque) under the skin of the penis. This causes a curvature during erection, which can be painful and make sexual intercourse difficult. Although it is more common in older men, Peyronie's disease is less frequent in men under 30. Major risk factors include:

  • Family history.
  • Treatments for prostate cancer.
  • Penile injuries, such as trauma during sexual activity or accidents.
  • Connective tissue diseases or autoimmune conditions.
  • Diabetes or erectile dysfunction.

A urologist can diagnose Peyronie's disease through a review of medical and family history, along with a physical examination. Treatment options may include oral medications, injections, or surgical options.

Kidney Stones

Kidney stones are small aggregates of mineral salts, often composed of calcium or other crystallizable substances, that form in the urinary tract. They can range in size from a grain of sand to a pearl and, in most cases, are asymptomatic and are expelled spontaneously without causing issues. However, in some cases, they can become lodged in the urinary tract, causing symptoms such as:

  • Severe pain.
  • Blood in urine.
  • Fever and chills.
  • Nausea and vomiting.
  • Foul-smelling or cloudy urine.
  • Burning sensation during urination.

These symptoms require prompt medical intervention. The formation of kidney stones can depend on various factors, including family history, an unbalanced diet, and poor hydration. To diagnose kidney stones, a urologist may prescribe urine and blood tests, as well as imaging studies such as X-rays, ultrasounds, or CT scans. Treatment varies depending on the type of stones. In some cases, dietary changes and increased fluid intake can help prevent or manage stones. However, for larger or more complex stones, treatments such as shock wave lithotripsy or surgical procedures may be necessary.

Post-Prostate Surgery Incontinence

The prostate surrounds the bladder, so when it is removed or treated with radiation, the nerves and muscles of the bladder, urethra, or sphincter can be damaged. This can lead to stress urinary incontinence, a condition where the pelvic floor muscles fail to effectively control urination, resulting in involuntary leaks.

Pelvic floor exercises are often recommended to strengthen the muscles and improve urinary control. In many cases, incontinence resolves within a year of prostate surgery. However, if the problem persists, surgical intervention may be necessary. Surgical options include:

  • Artificial urinary sphincter, a mechanical device that helps close the bladder outlet.
  • Urethral sling procedure, which involves inserting a synthetic mesh to support the urethra and reduce leakage.

If you have concerns or are experiencing any of the symptoms described above, make an appointment with one of our specialists in Urology and Andrology.