If eyes are the window to the soul, then the penis is the measuring stick of men’s heath.
While many men think a dodgy todger is a natural part of ageing, penis health is actually the canary in the coal mine.
Due to its intricate network of blood vessels and nerves, and the complex structure of muscles in the pelvis, the penis is uniquely sensitive to many common medical problems.
This means that when your heart or metabolic system starts to falter, the first warning signs often show up below the belt. This can manifest as erectile dysfunction or troubles with urination.
Sam Tafari, Andrology and Men’s Health Fellow at the Central Adelaide Local Health Network, puts it this way: “Erectile dysfunction and nocturia [urinating a lot overnight] signal problems elsewhere in the body.”
Your testosterone is probably fine
When their post gives up the ghost, many men suspect their testosterone might be at fault. Hormones are a part of the story, but more of a sidekick than a main suspect in this particular mystery.
“Only a small proportion of men with erectile dysfunction truly have low testosterone. The vast majority have other issues.” Sam points out.
“A whole list of problems that can affect your blood testosterone levels. It requires looking through it and finding out what the root cause of someone’s symptoms are. Testosterone levels will go down with all sorts of things that make you sick, so our job is to find out what those things are and fix them, rather than putting on a band-aid with testosterone supplementation”
“There are many causes of a low serum [blood] testosterone concentration, the most common of which is obesity and metabolic syndrome. It is important not to default to treatment with testosterone unless a diagnosis of pathological hypogonadism can be established.”
Research shows that there’s no significant connection between blood testosterone levels and erection quality.
If your erections aren’t hitting the mark like they used to, more hormones probably won’t help and could even make the problem worse. It’s like painting your car red in the hope it’ll go faster instead of going to the mechanic to fix the real problem.
When getting hard is getting hard
“ED is serious, it’s associated with other problems, and you need to see a doctor,” says Sam. “It’s common, but it’s important medically. It’s something to see a doctor about and get your penis health checked out”
Of men who have had a heart attack, 50% report experiencing some kind of erectile dysfunction in the years leading up to it.
“In men who have erectile dysfunction, the risk of having a heart attack goes up quite substantially, and that’s correlated with the degree of erectile dysfunction,” Sam warns.
“If you have really bad erectile dysfunction there’s an even higher risk than someone who has mild erectile dysfunction.”
The reason for this is simple – the penis is a unique organ filled with arteries, veins and spongy tissue, and it relies on good blood flow to work properly. If something in the body is damaging blood vessels, hard erections are the first to go.
“Lower severity erectile dysfunction might be someone who is still able to get an erection, but maybe can’t get it fully rigid,” explains Sam.
“Whereas someone who has very substantial erectile dysfunction may not be able to get an erection at all, or may get a very mild erection. And even with the addition of things such as viagra or cialis, they won’t get a particularly good erection.”
These symptoms mean urine trouble
Lower urinary tract symptoms (LUTS) are problems with holding it in, or problems with letting it go.
Problems with holding it in include things like needing to get up multiple times in the night to urinate (nocturia), feeling sudden uncontrollable urges to urinate, or needing to urinate frequently.
Problems with letting it go look like trouble getting started, after-dribble, and having a lacklustre stream.
Of these, nocturia is the most obvious sign of a problem. And the more often you need to get up in the night, the higher your risk of severe disease.
“We define high frequency as getting up to urinate two or more times a night. Some men will be getting up every second hour to urinate and that’s quite severe.”
How exactly chronic disease causes urinary symptoms is still unclear, but a lot of it has to do with inflammation.
Inflammation is a process that happens when your immune system detects an injury or foreign object in your body. It quickly launches an attack to eliminate the threat and repair the wound – but in the heat of battle, can also cause collateral damage to the very thing it was trying to protect: your body.
Just as inflammation in blood vessels can lead to high blood pressure and inflammation in the airways can lead to asthma, inflammation in the sensitive tissues of the penis and bladder can affect erections and urination.
Triggering better health services for men
Your penis isn’t just a handy sundial or a place to hang your hat. In a way, penis health is an avatar of your body’s overall health.
“The more severe your erectile dysfunction or lower urinary tract symptoms are, the more likely it is you have dysglycaemia [abnormal blood sugar levels], hypertension [high blood pressure], dyslipidaemia [high cholesterol] and an increased risk of having a heart attack, heart failure, or a stroke,” explains Sam.
However, these symptoms can also indicate conditions as far-ranging as depression, sleep apnoea, inflammatory bowel disease, and gum disease.
Even many doctors are unaware of the link between penis troubles and chronic diseases.
“So many men – even myself as a medical student and as a junior doctor – are just under the impression that nocturia has to do with a large prostate, and it just happens to all old men.”
“The opportunity to intervene early is lost because men are not asked about these important problems – or if they are, general practitioners may not be sufficiently aware of the implications of these symptoms.”
“Our work has shown that men tend not to volunteer information beyond the immediate problem when they visit their GP, and yet 70% feel that their problems are incompletely addressed. Men do not necessarily volunteer information, but wait to be asked.”
To tackle this, he’s developing a questionnaire for men to fill out in GP waiting rooms, asking specific, direct questions about penis health.
“Erections and a good night’s sleep are representative of a healthy man. As doctors we owe it to the men we care for to ask two critical questions: any trouble with erections? And are you regularly getting up to pass urine two or more times? If the answer to either is yes then a thorough assessment is required.”
A midnight dash to the loo might seem like an annoyance, and performance issues can appear to be an inevitable part of ageing. But don’t just throw it over your shoulder like a continental solider – talk about your penis health with your GP next time you’re there.
