MEN'S HEALTH MATTERSYour health questions answered
Q I recently attended a sexually transmitted infection clinic. While I was waiting to be seen I read that a significant number of men ignore the risks associated with unprotected sexual exposure. I was amazed by this and wondered how we could improve the awareness of the importance of sexual health.
A Sexual health in men in Ireland is under-addressed. Many men (and women) overlook the serious direct and indirect consequences that relate to sexual health. Some conditions are specific to men, but many are intrinsically related to sexual and general health in both men and women.
Sexually transmitted infections (STIs) are a major cause of morbidity with a direct economic burden as well as psychological sequelae. Most recent provisional data from the Health Protection Surveillance Centre reports STI notification rates in men of 58.5 per cent. Many men have a low awareness of the concept of sexual health, where services are available and are often reluctant to use them.
The risk of both the acquisition and transmission of HIV is greatly increased when another STI is present in either partner. Serious systemic illnesses such as syphilis can have life-threatening complications.
Recurring genital conditions such as herpes or genital warts place direct physical and emotional strain on the patient, take up health resources and, for herpes, are a cause of considerable days lost in the workplace.
A service well structured to deal with sexual health in men, as for women, can lead to health improvements, economic gain to society and removal of stigma.
It is obvious that we need to improve access to and the use of sexual health services for men. Recent recommendations outlined by a HSE study include the need for better sex education for young people, better public awareness of sexual health services, especially directed at men, better training of sexual health professionals in men's health issues, and increasing men's access to condoms.
In its broader definition, sexual health will need to be more holistic in its approach and not purely infection-focused.
Q I have prostate cancer and have had several tests to confirm this. The cancer is going to be treated with radiotherapy and my doctor has told me that I now need to have a Cat scan, an MRI and a bone scan. Is all this necessary and why can't I have just one scan?
A The doctors need to "stage" your cancer accurately, ie find out whether the cancer has spread and if so to where. Ideally, it would be nice to have a single scan but at present no single scan gives all of the information necessary. Most patients do not require both a Cat (or CT) scan and an MRI, however, in your case your doctor feels that he requires more detailed information prior to arranging your radiotherapy.
You need a bone scan to determine whether the cancer has spread to the bones. The bone scan does not give any useful information about the prostate itself or spread elsewhere.
A CT scan gives excellent information regarding possible spread to the thorax (usually to the lungs) or abdomen (eg to the liver or lymph glands) but gives poor information about the prostate itself. Both the bone scan and the CT scan do expose a patient to (ionising) radiation.
An MRI scan does not expose you to "radiation" and yields excellent detail of the prostate gland itself. It may help deter- mine if the cancer has spread outside the prostate gland although it is not 100 per cent accurate.
This column was edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with contributions from Dr Colm Bergin, consultant in infectious diseases, St James's Hospital and Dr Jim Meaney, consultant radiologist, St James's Hospital