Men, we've got answers to the health questions you may be too afraid to ask
Testosterone level, testicle size and more — the doctor is in
Though many are magical, some of the human body's functions (and dysfunctions) can be disgusting, frustrating and downright weird. So it's no surprise that discussing some of its more sensitive operations can be embarrassing. And while this may cause anyone to be reluctant to talk about their health concerns, it seems men, in specific, are most hesitant about it.
Vancouver-based health writer and physician Melissa Lem sees this clearly as a family doctor — usually the first person to field our body-related questions. "An informal survey of my own patients over the past week showed that I saw almost twice as many women as men," she says. That finding is consistent with Canadian research suggesting women visit the doctor more often, and research conducted by the American Academy of Family Physicians that suggests men are less likely to get their recommended routine screenings. Dr. Lem says she often hears comments like, "I didn't want to come in today, but my wife/girlfriend told me to," along with "doorknob questions" — the most sensitive questions men save and ask when they're just about to leave the exam room.
As to why this is, Dr. Lem believes it's a combination of socialization and habit. "Men are frequently taught from a young age that complaining is a sign of weakness. Studies show that men who hold more traditional views of masculinity are more likely to avoid doctors and minimize their symptoms," she says. "Interestingly, research also shows that men tend to be more honest about their health with female doctors." Dr. Lem also notes that since women are more likely to visit the doctor from a young age to address birth control and begin routine screenings, such as Pap tests, it's usually a habit they form earlier.
Of course, avoiding addressing health concerns can have grave consequences. "Canadian men tend to have higher rates of chronic health conditions, such as diabetes, heart disease and cancer," says Dr. Lem. "Not only that, they die an average of four years earlier than women." When men do visit the doctor, she says that they are often most reluctant to discuss "issues that involve sensitive parts of the body, their sexual health and mood."
With all of this in mind, we reached out to family doctor and sexual health expert Manisha Sharma of Ontario's Oakwood Health Network, which specializes in treating erectile dysfunction. We asked her some of your most delicate questions — consider it a primer before you finally reach out to your own GP.
Why is my penis curved?
No matter which way it points, a curve is common. The condition is called Peyronie's disease, says Dr. Sharma, and it affects about 10 per cent of the male population. "It's typically caused by scar tissue that has formed on one side of the penis," she says. "Usually the curve isn't painful and doesn't interfere with sex, but in some cases it can." Fortunately, Peyronie's disease is treatable. A urologist or specialized clinic may treat it with medication, surgery or shockwave therapy.
One of my testicles is bigger or hangs lower than the other; is this normal?
It may feel weird, but "it's totally normal," Dr. Sharma says. She adds that if you're concerned about a difference in size, you can ask your family doctor to take a look. (Fun fact: In terms of the way they hang, it may be an evolutionary feature. Fluctuating "scrotum hang" allows for temperature regulation — finicky sperm is produced and stored more effectively away from body heat, yet doesn't like to be too cold — plus the system is structured in a way that lets each testicle migrate independently to keep things optimal.)
Why am I urinating more frequently?
A change in how often or how much you're urinating can be a symptom of a variety of issues, including a urinary tract infection (which is often also painful), prostate issues or a weakened pelvic floor, says Dr. Sharma. The pelvic floor is a muscle that supports your internal organs and "it plays a big role in urinating, defecating, erections and orgasms," so it's important to keep it healthy and strong. "Talk to your family doctor about changes in your typical urinary patterns," she says, to get to the root of the problem.
Do I have low testosterone? Do I need higher testosterone?
"Testosterone levels fall as men age," Dr. Sharma notes. However, if you have lower than normal levels, such a deficiency can bring along a host of symptoms, such as tiredness, erectile dysfunction and loss of muscle mass. If you suspect lower-than-normal testosterone levels, Dr. Sharma says that your doctor can order a simple blood test to see if your level falls within the normal range and, if you're low, suggest the best form of treatment.
Can supplements raise my testosterone level?
No, supplements will not raise your testosterone level. However, if you want to naturally support your testosterone levels, Dr. Sharma suggests keeping off excess weight and exercising regularly.
Is erectile dysfunction (ED) caused by low testosterone?
Assuming that low testosterone negatively affects a man's erectile capabilities may seem logical, but it isn't always the case. "Not all men who have ED have low testosterone," says Dr. Sharma, "and not all men with low testosterone have ED." There are a host of factors that contribute to ED, she explains. Since blood flow plays a significant role in erections, anything that interferes with blood flow to the penis, such as age, smoking, excess weight, certain prescription medications and health conditions like diabetes and low testosterone, can impair erection.
What can I do about ED?
"When treating ED, it's important to have a variety of strategies available," says Dr. Sharma, and this might include taking prescription pills (though "they don't work forever, some men can't take them and they have side effects"). Lifestyle changes such as improving fitness and nutrition, strengthening the pelvic floor and seeking therapy for unresolved anxiety or trauma (since ED can be mental health–related) are other potential strategies. Shockwave therapy and penile pumps can also serve to aid the issue, she says. Talk to your doctor to determine the appropriate course of action.
Does having ED mean I'm sterile?
The erectile system is separate from sperm production and quality, so having ED doesn't necessarily mean you're sterile. However, the issues can go hand in hand. "Men who experience fertility issues can also have ED," says Dr. Sharma. "If you suspect a fertility issue, your doctor can refer you for testing."
I don't have ED, but I do have a low sex drive. Why?
Sex drive, like the ability to achieve an erection, can be affected by a variety of factors, such as age, low testosterone and certain prescription medication, Dr. Sharma explains. "However, if you can get good erections but have no desire to have sex, you could [also] be dealing with a mental health issue." Stress can be an obstruction to sexual enjoyment and/or desire, she says, as can depression. Seeing a mental health professional, either alone or with your partner, can help pinpoint, treat and manage these issues.
How can I stop premature ejaculation? Are there things I can do at home?
Managing stress and professionally treating larger issues such as depression and anxiety is key, says Dr. Sharma, as these things are all believed to be contributing factors to premature ejaculation. "If you have ED, treat it," she adds. "Men with ED tend to climax sooner as they fear the loss of the erection." If possible, Dr. Sharma suggests masturbating one to two hours before sexual activity, and keeping the pelvic floor strong through physiotherapy. The pause-squeeze technique might also be helpful: when the urge to ejaculate occurs, have your partner squeeze where the head of your penis meets the shaft until the sensation passes (this may take several seconds) and repeat as needed.
What does my prostate do, and how do I know if there's an issue with it?
The prostate gland is a male reproductive organ that aids in the production of semen. "It's below the bladder, [in front] of the rectum and it goes around the tube that carries urine and semen out of the body," says Dr. Sharma. Because of its location, when the prostate becomes enlarged, it can constrict the urethra and obstruct urine flow. "Discuss with your doctor if you have difficulty completely emptying your bladder, a weak, dribbling urine stream or [are] urinating frequently at night," she advises.
At what age will my sex drive decrease, and what can I do about it?
Sex drive tends to decrease as we age, however, Dr. Sharma notes that men can retain and prolong their sexual drive well into their 60s, 70s and beyond. She highlights losing weight and exercising (giving you more energy), diagnosing and treating low testosterone, and reducing stress or anxiety as keys to preserving and increasing your sex drive.