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Things to know about ‘Dhat’ syndrome (Nocturnal emission/Nightfall)

What is meant by nightfall or nocturnal emission or wet dreams?

Spontaneous involuntary loss of semen while the person is in sleep is called as nightfall or nocturnal emission. It is most common in young boys (adolescent age group).

Is there any side effects of night fall ?

There is no evidence that nightfall (wet dreams/nocturnal emission) cause any bodily side effect in men.

What is Dhat disease or Dhat Syndrome ?

Dhat syndrome is the clinical entity seen primarily in Indian subcontinent and present with a features of depression, anxiety, multiple nonspecific body symptoms, sexual dysfunction, fatigability, and impairment of concentration, which are attributable to semen loss. Loss of semen irrespective of the mechanism (during urination, defecation, masturbation, nightfall or nocturnal emission, and even sexual intercourse) is considered worrisome by patients suffering from Dhat syndrome.  

Which age group are mainly affected with Dhat syndrome ?

Patients with Dhat syndrome are often young males in second to third decade of life. Majority of the patients belong to south east Asia continent and belong to low socio-economic groups with orthodox culture. Families with poor education have higher chances of having this entity.

What are the symptoms of Dhat syndrome ?  

The most common presenting symptoms in patients with Dhat syndrome are weakness of the body, tiredness, low energy, low mood and mental stress. It can also be described as the abnormal illness behavior and bodily symptoms due to semen loss, as well as heightened emotional (depression and anxiety) response. These symptoms often get amplified with the stress.

How the symptoms of Dhat syndrome develop ?

At the time of onset of Dhat syndrome, these people get excessively worried with having nightfall or semen discharge and gives lot of significance to this semen loss. Every time they loss semen, they experience stress (as it is not acceptable in their culture). This abnormal thinking leads to stress response which further gets amplified with each time person have semen loss and hence this vicious cycle goes on. Further exaggeration of this stress response leads to the symptoms of anxiety, depression and other body (somatic) symptoms. This anxiety feature can lead to sexual dysfunction seen in few men with Dhat syndrome. Nearly 20% of patients diagnosed with Dhat syndrome do harbour some underlying depression, anxiety disorder.

How to treat Dhat syndrome ?

The patient with Dhat syndrome approach a variety of medical practitioners and specialists with their complaints. Since this culture originated disease entity is rare in western countries, the presentation and management knowledge is deficient in western medical practitioners. Patients with Dhat syndrome require comprehensive assessment to assess clinical severity. Integration of various medical specialities such as Urology, Psychiatry, Psychologists, general medicine, psychiatric nurses, alternative medicine (Ayurvedic/Siddha) can lead to better patient management. Psychosocial therapy, cognitive behavior therapy (imparting sex education and resolving sexual myths is very important), antianxiety and antidepressant therapy are helpful. Educating the traditional healers may help in resolving the sexual myths that they carry and dissipate to the people in the society.

Guide to chronic prostatitis: symptoms, diagnosis and treatment

What is prostate gland ?

Prostate is a walnut sized reproductive gland present below the bladder in all men. Urethra (urinary passage) passes through it. Its function is to provide nutrition to the sperms.

What is prostatitis ?

Prostatitis means that you have inflammation of your prostate gland. Prostatitis can present in short time duration with fever/chills (acute prostatitis) or can have persistent course (chronic prostatitis) and can have either infective or non-infective etiology.

What is meant by chronic prostatitis ?

Chronic prostatitis is the persistence of inflammation in the prostate for more than three months. It can be either infectious or non – infectious. Majority of patients have non infectious cause of chronic prostatitis and only 1 in 10 diagnosed having bacterial cause of infection. Read more about urinary tract infection at Urinary tract infection (UTI)

What are the symptoms of chronic prostatitis ?

Symptoms of chronic prostatitis are variable and include – Burning micturition (painful urination), pain in the penis, scrotum or suprapubic region, difficulty in initiating urinary stream, frequent urge of passing urine, poor urinary stream, sensation of having residual urine in bladder after passing urine, dribbling at the end of passing urine, pain while ejaculation or during orgasm etc. These symptoms may be very subtle in few patients but can be very annoying and bothersome in others, interfering in daily activities, work and sexual life. (Know the symptoms of enlarged prostate at BPH (Enlarged prostate) Symptoms)

How to make a diagnose of chronic prostatitis ?

Diagnosis of chronic prostatitis is made after detailed history and work up of the patient. Workup includes physical examination with digital rectal examination (DRE) to palpate the prostate and rule out any acute infection and laboratory tests such as urine examination and imaging with ultrasound to look for source of infection. EPS (Expressed prostatic secretions) which are drops of urethral discharge obtained after DRE and initial urine sample after DRE helps in ruling out any bacterial infection within prostate. Occasionally doctor may advice cystoscopy to look at urethra, prostate and bladder for any pathology. Read how to diagnose BPH at Prostate enlargement diagnosis

What is the treatment of chronic prostatitis ?

Lifestyle changes

Use of heating pad or sitz bath (soaking lower body half in warm water), limiting caffeinated products such as cold drinks, tea, coffee, cutting down alcohol intake, avoid spicy and acidic food, avoiding large amount of fluid intake at a time, avoid prolonged sitting, daily brisk walk for atleast 15 minutes, pelvic relaxation exercises etc helps in improving symptoms.

Medical treatment

  1. Alpha blocker – This medicine relax the bladder neck and prostate muscle fibers and helps in easing pain or voiding symptoms associated with chronic prostatitis.
  2. Antibiotics – Role of antibiotics are controversial when urine examination tests are normal, but use of antibiotics for 2-3 weeks (Doxycycline, fluoroquinolones) are often prescribed for any subclinical infection harboring in the prostate.
  3. Analgesics and Anti-inflammatory drugs – Painkillers and anti-inflammatory drugs (NSAIDs) helps reducing inflammation and reduces pain. Other neuropathic painkillers such as pregabalin helps in few patients.
  4. Muscle relaxants – These drugs helps in relaxing spasm of pelvic floor muscles.
  5. Prostatic massage – Prostatic massage helps reducing inflammation and reduces the symptoms of chronic prostatitis.

What is the prognosis of chronic prostatitis ?

Chronic prostatitis is poorly understood entity and its association with infection is subtle. Hence, this disease is very difficult to cure with many men do not respond to the therapy . Nonetheless, several potentially effective treatments are available. Your urologist may be able to help out in alleviation of symptoms associated with this disease.

Does chronic prostatitis increase the risk of prostate cancer ?

There is no evidence that chronic prostatitis increases the risk of developing prostate cancer. Read more about prostate cancer and its diagnosis at Prostate cancer

8 tips to prevent recurrent kidney stone formation

  1. Adequate fluid intake – Drinking plenty of oral liquids helps in reducing the chances of stone formation. It is estimated that nearly 50% of stone formations is due to less liquid intake. More concentrated urine leads to less dissolution of salts in it and thus leading to high chances of urinary stone formation. One should drink at least 2.5-3.0 litres of liquids per day so that the urine output remains nearly 2.0 litre/day. Citrate containing fluids such as orange and other citrus fruits decreases risks of stone formation.
  2. Calcium intake – Vitamin D deficiency often leads to excessive secretion of calcium in urine. Vitamin D supplementation along with calcium rich diet helps preventing renal stone formation. Calcium containing supplements should be taken along with the meals.
  3. Low salt intake – Avoiding excessive salt in the diet is beneficial and reduces the risk of calcium stone formation. Low salt in diet leads to less excretion of calcium in urine and hence less chances of calcium stone formation.
  4. Reduce body weight – Obesity with metabolic syndrome persons are prone to develop uric acid stones. Reducing body weight decreases the chances of uric acid stone formation.
  5. Avoid oxalate rich diet – Diet such as nuts, cashew, cocoa, chocolates, spinach, coffee, beet, rhubarb etc is rich in oxalate. Oxalate present in the food bind with the calcium in gut and does not get absorbed. Excessive oxalate gets reabsorbed in gut and get excreted in urine and increases chances of calcium oxalate stone formation. Avoiding such diet helps reducing the risk of these stone formation.
  6. Avoid excessive vitamin C intake – Excessive of vitamin C or its supplement increases the risk of stone formation. Other micronutrients such vitamin B6 helps reducing formation of stone.
  7. Get stone analysis – If someone has recently passed a stone or operated for stone disease, he/she should get the stone analysis done. It helps in knowing the composition of stone and hence doctor takes appropriate measures either with changes in food habits or starting some medicine, so as to decrease the chances of formation of stone disease.
  8. Prevent recurrent urinary tract infection – Recurrent urinary tract infection also leads to the formation of certain types of renal such as struvite stones. Preventing recurrent UTI helps decreasing the episodes of such types stone formation.

Premature ejaculation- causes, diagnosis and treatment

What is premature ejaculation ?

Premature ejaculation is defined when a man ejaculates sooner during sexual intercourse than he would like to. Nearly one third male experience this problem at some point of time. Premature ejaculation is diagnosed by a doctor when a male presents with complaints such as –

  • 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 tendency to avoid sexual intimacy therefore

What is the presentation of premature ejaculation ?

Premature ejaculation can be either of two types – Primary (Lifelong) and Secondary (Acquired). When a male presents with history of premature ejaculation nearly all of the times during sexual acts since the start of his first sexual encounter, it is called as primary type. Secondary type or acquired premature ejaculation is the one where a man who did not had ejaculation problems to begin with, start having early ejaculation now.

What are the causes of premature ejaculation ?

Premature ejaculation can be broadly divided into – Psychological causes and organic causes.

Psychological causes – Various factors such as poor body image, depression, previous sexual experiences, sexual abuse etc can lead on to the premature ejaculation.

Organic causes – Erectile dysfunction, anxiety disorder, hypogonadism (Testosterone and Testosterone deficiency syndrome), abnormal hormone levels etc.

How the diagnosis of premature ejaculation made ?

The diagnosis of premature ejaculation is made on the patient’s history. Repeated or very often episodes of very early ejaculation which cannot be delayed or postpone by the person, points towards premature ejaculation. There is high chances of patient with premature ejaculation who is also suffering from erectile dysfunction and hence the evaluation of such disorder is also done.

What is the treatment for premature ejaculation ?

There are various methods to treat premature ejaculation, and often either one or combination of these used for the any patient.

  • Pelvic floor muscle exercises – Kegal exercises where the pelvic floor muscles are tightened and to hold it in contraction for three seconds, and then relax for three seconds. This is tried a few times in a sequence. Kegel exercises can be done while sitting, standing or walking.
  • Squeeze technique – In this method, the sexual activity is started as usual till the level of stimulation and at the peak of stimulation before the ejaculation, the sexual activity is stopped and either partner or male himself squeeze the penis till the urge to ejaculate goes off and then subsequently sexual activity can be resumed. This process can then be repeated again.
  • Use of condoms – Condom application leads to decrease in sensation and helps delaying ejaculation therefore.
  • Topical anesthetics – Anesthetic creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. Side effect include that some men report temporary loss of sensitivity and decreased sexual pleasure.
  • Medications – Many oral medications are used to delay the ejaculations. These medicines include SSRI (escitalopram, paroxetine, fluoxetine, dapoxetine), Tricyclic antidepressant (Clomipramine), tramadol, phosphodiesterase inhibitors (sildenafil, tadalafil). Use of SSRI and clomipramine may take few days to show its effect completely.

Whom to consult if someone suffering from premature ejaculation ?

You should consult your nearby andrologist if you or your partner suffering from premature ejaculation.

Prostate cancer – Part I

What is prostate ?

Prostate is a lemon sized reproductive gland, found only in men, below the bladder. Its function is to produce fluid which helps providing nourishment to sperms in semen. Urinary passage goes through prostate, before reaching the penis.

What all diseases can occur in prostate ?

BPH (BPH (Enlarged prostate) Symptoms), Prostatitis (Infection in prostate), Prostate cancer (Prostate cancer)are the most common diseases that originate from prostate.

What is prostate cancer ?

Like rest of the body cancers, prostate can harbour cancer in it. Malignant growth inside the prostate is called prostate cancer. Most of the prostate cancers are slow growing.

What are the risk factors for prostate cancer ?

Older age, African – American race, family history of ovarian/breast and prostate cancer increases the likelihood of a man being diagnosed with prostate cancer. As men increase in age, the risk of prostate cancer increases. About 60% of prostate cancers are diagnosed in men over the age of 65 years. Besides these, diet high in animal fat has been associated with risk of developing prostate cancer.

What are the symptoms of prostate cancer ?

Prostate cancer can be asymptomatic; meaning there can be no symptoms of cancer. If it does causes symptoms, these can be urinary symptoms or more generalised symptoms, depending upon the stage of prostate cancer. Most common symptoms include- urinary symptoms such as frequency or weak urinary stream, blood in urine (hematuria), erectile dysfunction (ED), Hematospermia (Blood in semen), urinary and bowel incontinence, pain in hips/back/legs etc.

Can we detect prostate cancer in patient who does not have symptoms ?

Prostate cancer can be easily screened with combination of Digital rectal examination (DRE), conducted by doctor and blood test called PSA (Prostate specific antigen). (Prostate cancer and PSA testing). These tests are recommended annually in men over 50 years of age. Combination of these tests can diagnose prostate cancer in men, in whom there are no symptoms of this disease.

What is PSA test ?

The PSA is a blood test which is commonly used to detect possible prostate cancer in a person. Elevated PSA levels may indicate the presence of prostate cancer, but it can be also elevated in certain conditions of prostate such as BPH, prostate infections (prostatitis), UTI (Urinary tract infection), retention urine etc.

If initial tests shows risk of prostate cancer, what happens next ?

The final diagnosis of prostate cancer is made after prostate biopsy done most commonly by ultrasound guidance called TRUS (Trans rectal Ultrasound). Sometimes doctor orders MRI called mpMRI (multiparametric MRI) prostate before undertaking biopsy. Once biopsy shows evidence of prostate cancer, the cancer is staged to look for the extent of cancer spread into the body. This is done by combination of various modalities such as CT scan, MRI , Bone scan and more recently PSMA PET scan.

Testosterone and Testosterone deficiency syndrome

What is testosterone ?

Testosterone is the male hormone which helps in the physical, sexual and psychological well being of the person.

What is the role of testosterone hormone in male body ?

Testosterone helps in development of male secondary characters at puberty such as growth of facial hairs, penis and testes enlargement, deepening of voice, bony and muscle growth etc. In grown adults, this hormone helps in maintaining muscle and fat mass, safeguarding cardiovascular health and producing blood cells, keeping emotional stability, maintaining sexual life while keeping libido, sexual desire, penile erection and fertility normal.

What are sign and symptoms of testosterone deficiency in men ?

Sexual symptoms – Decreased libido; erectile dysfunction; decreased frequency of
morning erections; decreased performance

Physical symptoms – Increased visceral body fat/obesity; decreased lean muscle mass;
decreased strength; fatigue/loss of energy; decreased physical activity/
vitality; low bone mineral density; anemia; flushes; loss of facial, axillary
and pubic hair/slow beard growth; decline in general feeling of well-being

Psychological symptoms – Depression/depressed mood; mood changes; irritability;
inability to concentrate; insomnia/sleep disturbances

Which persons are at risk of developing testosterone deficiency syndrome ?

Persons with poorly controlled diabetes, high BMI, kidney failure on dialysis, chronic alcohol consumer, liver disease, on cancer chemotherapy , drug addicts, COPD etc are at risk for testosterone deficiency and its symptoms.

How to check and evaluate for the testosterone deficiency ?

Testosterone is checked by the blood sample, taken in fasting state early morning between 8 am to 11 am. Normal levels of total testosterone in adult male is usually between 275 ng/dl – 875 ng/dl. Level below this range suggests testosterone deficiency.

How to treat if someone having low testosterone levels ?

If someone is having low serum testosterone levels, complete history and examination for sign and symptoms is must for such patients, as only low testosterone levels does not warrants its treatment. If there are corroborative sign and symptoms along with low testosterone level, the treatment is usually initiated with either intramuscular (i.m.), oral and gel preparations.

Whom to consult for if someone has low testosterone levels ?

You should meet Andrologist for the evaluation and treatment of low testosterone levels.