For HCPs

An enlarged prostate (also called Benign Prostatic Hyperplasia, BPH) occurs when a man’s prostate gland slowly grows bigger as he ages. More than half of men over age 60 have this condition, also called benign prostatic hyperplasia (BPH). Some men have symptoms and others don’t. The exact causes are unknown, but one thing is sure: BPH is not cancer and it does not lead to cancer. The prostate sits below the bladder and produces fluid for semen.

SYMPTOMS

• Urinary frequency—urination eight or more times a day
• Urinary urgency—the inability to delay urination
• Trouble starting a urine stream
• A weak or an interrupted urine stream
• Dribbling at the end of urination
• Nocturia—frequent urination during periods of sleep
• Urinary retention
• Urinary incontinence—the accidental loss of urine
• Pain after ejaculation or during urination
• Urine that has an unusual color or smell

Complications caused by benign prostatic hyperplasia may include

• Acute urinary retention
• Chronic, or long lasting, urinary retention
• Blood in the urine
• Urinary tract infections (UTIs)
• Bladder damage
• Kidney damage
• Bladder stones

SOME CAUSES OF SYMPTOMS INCLUDE

• A blocked urethra because of the enlarged prostate
• A bladder that is overworked from trying to pass urine through the blockage

DIAGNOSIS
To ensure a correct diagnosis our Doctors may perform a few exams and tests such as:

• Review of personal and family medical history
• A physical exam – This may include checking for:

Discharge from the urethra
Enlarged or tender lymph nodes in the groin
A swollen or tender scrotum

• Taps on specific areas of the patient’s body
• Digital rectal exam

Medical tests may include:

• Urinalysis
• A prostate-specific antigen (PSA) blood test
• Urodynamic tests
• Eystoscopy
• Transrectal ultrasound
• Biopsy

TREATMENT
1.Lifestyle changes

• Reducing intake of liquids, particularly before going out in public or before periods of sleep
• Avoiding or reducing intake of caffeinated beverages and alcohol
• Avoiding or monitoring the use of medications such as decongestants, antihistamines, antidepressants, and diuretics
• Training the bladder to hold more urine for longer periods
• Exercising pelvic floor muscles
• Preventing or treating constipation

2.Medications
3.Minimally invasive procedures
4.Surgery

PATIENT FAQ’S
How can benign prostatic hyperplasia be prevented?
Researchers have not found a way to prevent benign prostatic hyperplasia. Men with risk factors for benign prostatic hyperplasia should talk with a health care provider about any lower urinary tract symptoms and the need for regular prostate exams. Men can get early treatment and minimize benign prostatic hyperplasia effects by recognizing lower urinary tract symptoms and identifying an enlarged prostate.

Eating, Diet, and Nutrition
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing benign prostatic hyperplasia. However, we can give information about how changes in eating, diet, or nutrition could help with treatment. Men should talk with their doctor about what diet is right for them.

Who Gets an Enlarged Prostate?
Most men get an enlarged prostate as they age. The prostate gland grows throughout most of a man’s life, first at puberty and then from about age 25 on. It usually doesn’t cause symptoms before the age of 40. But by age 85, up to 90% of men have symptoms. Only about a third of men with an enlarged prostate are bothered by symptoms.

What Causes the Prostate to Gro
No one knows for sure. It is believed that different hormones such as testosterone, DHT, and estrogen may play a role. It is also unclear why some men with BPH will have symptoms while others do not. Vasectomy and sex do not raise the risk of having BPH.

Erectile Dysfunction (ED) or impotence describes the inability to get and maintain an erection firm enough for sex. Men often find the situation embarrassing, but it’s important to remember that there are a variety of proven treatment options available.

ADVANCED TREATMENT FOR ERECTILE DYSFUNCTION
Occasional erection problems aren’t always a cause for concern, however if the problem is an ongoing issue it can result in reduced quality of life as a result of stress, self-confidence issues and relationship problems. Erectile dysfunction can also indicate an underlying health condition and is a potential risk factor of heart disease.

SYMPTOMS OF ERECTILE DYSFUNCTION
Diabetes and heart disease are well known conditions linked to ED.  Symptoms

• Difficulty getting an erection
• Difficulty keeping an erection
• Reduced sexual desire

CAUSES AND RISK FACTORS OF ERECTILE DYSFUNCTION
There are several factors involved when it comes to arousal that include both psychological and physical factors.

COMMON PHYSICAL & MEDICAL CAUSES OF ERECTILE DYSFUNCTION

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Parkinson’s disease
• Multiple sclerosis
• Certain prescription medications
• Tobacco use
• Peyronie’s disease (scar tissue inside the penis)
• Alcoholism & substance abuse
• Sleep disorders
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord

PSYCHOLOGICAL CAUSES OF ERECTILE DYSFUNCTION
The brain plays an integral part in the events that lead to an erection.  Various factors can interfere with sexual feeling and sexual excitement such as:

• Stress & anxiety
• Depression, low self-esteem or other mental health conditions
• Relationship problems
• Unsatisfactory sex life
• low self-esteem

PREVENTION OF ERECTILE DYSFUNCTION
A healthy lifestyle and appropriate management of any existing medical conditions is one of the best ways to prevent erectile dysfunction. This includes:

• Management of diabetes, heart disease or other chronic health conditions
• Quit smoking
• Avoid alcohol and drugs
• Regular exercise
• Stress management
• Get help for anxiety, depression or other mental health concerns

Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time.

As long as it happens infrequently, it's not cause for concern. However, you might be diagnosed with premature ejaculation if you:

• Always or nearly always ejaculate within one minute of penetration
• Are unable to delay ejaculation during intercourse all or nearly all of the time
• Feel distressed and frustrated, and tend to avoid sexual intimacy as a result

Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed talking about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.

Symptoms
The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem might occur in all sexual situations, even during masturbation.

Premature ejaculation can be classified as:

• Lifelong (primary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters.
• Acquired (secondary). Acquired premature ejaculation develops after you've had previous sexual experiences without ejaculatory problems.

Many men feel that they have symptoms of premature ejaculation, but the symptoms don't meet the diagnostic criteria for premature ejaculation. Instead these men might have natural variable premature ejaculation, which includes periods of rapid ejaculation as well as periods of normal ejaculation.

When to see a doctor
Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.

For some men, a conversation with a doctor might help lessen concerns about premature ejaculation. For example, it might be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.

Causes
The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation involves a complex interaction of psychological and biological factors.

Psychological causes
Psychological factors that might play a role include:

• Early sexual experiences
• Sexual abuse
• Poor body image
• Depression
• Worrying about premature ejaculation
• Guilty feelings that increase your tendency to rush through sexual encounters

Other factors that can play a role include:

• Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse might form a pattern of rushing to ejaculate, which can be difficult to change.
• Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
• Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes
A number of biological factors might contribute to premature ejaculation, including:

• Abnormal hormone levels
• Abnormal levels of brain chemicals called neurotransmitters
• Inflammation and infection of the prostate or urethra
• Inherited traits

Risk factors
Various factors can increase your risk of premature ejaculation, including:

• Erectile dysfunction. You might be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection might cause you to consciously or unconsciously hurry through sexual encounters.
• Stress. Emotional or mental strain in any area of your life can play a role in premature ejaculation, limiting your ability to relax and focus during sexual encounters.

Complications
Premature ejaculation can cause problems in your personal life, including:

• Stress and relationship problems. A common complication of premature ejaculation is relationship stress.
• Fertility problems. Premature ejaculation can occasionally make fertilization difficult for couples who are trying to have a baby if ejaculation doesn't occur intravaginally.

Diagnosis
In addition to asking about your sex life, your doctor will ask about your health history and might do a physical exam. If you have both premature ejaculation and trouble getting or maintaining an erection, your doctor might order blood tests to check your male hormone (testosterone) levels or other tests.

In some cases, your doctor might suggest that you go to a urologist or a mental health professional who specializes in sexual dysfunction.

Treatment
Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, medications and counseling. Keep in mind that it might take time to find the treatment or combination of treatments that will work for you. Behavioral treatment plus drug therapy might be the most effective course.

Condoms
Condoms might decrease penis sensitivity, which can help delay ejaculation. "Climax control" condoms are available over the counter.


Medications
Topical anesthetics
A lidocaine-prilocaine cream for premature ejaculation (EMLA) is available by prescription. Lidocaine sprays for premature ejaculation are available over-the-counter.

Although topical anesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. Sometimes, female partners also have reported these effects.

Oral medications
Dapoxetine is a medication used for the treatment of premature ejaculation (PE) in men 18–64 years old. Dapoxetine works by inhibiting the serotonin transporter, increasing serotonin's action at the postsynaptic cleft, and as a consequence promoting ejaculatory delay. As a member of the selective serotonin reuptake inhibitor (SSRI) family, Dapoxetine was initially created as an antidepressant. However, unlike other SSRIs, Dapoxetine is absorbed and eliminated rapidly in the body. Its fast-acting property makes it suitable for the treatment of PE, but not as an antidepressant.

Many medications might delay orgasm. Although none of these drugs are specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics and phosphodiesterase-5 inhibitors. These medications might be prescribed for either on-demand or daily use, and might be prescribed alone or in combination with other treatments.

• Analgesics. Tramadol (Ultram) is a medication commonly used to treat pain. It also has side effects that delay ejaculation. Unwanted side effects might include nausea, headache, sleepiness and dizziness.

It might be prescribed when SSRIs haven't been effective. Tramadol can't be used in combination with an SSRI.

• Phosphodiesterase-5 inhibitors. Some medications used to treat erectile dysfunction, such as sildenafil (Viagra), tadalafil (Cialis, Adcirca) or vardenafil (Levitra, Staxyn), also might help premature ejaculation. Unwanted side effects might include headache, facial flushing and indigestion. These medications might be more effective when used in combination with an SSRI.

Counseling
This approach involves talking with a mental health provider about your relationships and experiences. Sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it's used in combination with drug therapy.

With premature ejaculation, you might feel you lose some of the closeness shared with a sexual partner. You might feel angry, ashamed and upset, and turn away from your partner.

Your partner also might be upset with the change in sexual intimacy. Premature ejaculation can cause partners to feel less connected or hurt. Talking about the problem is an important step, and relationship counseling or sex therapy might be helpful.