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Male Reproductive Health

Written by Dr Arien van der Merwe (MBChB FRSPH MISMA)

Sexual health challenges are very common in men over 40 years of age. Performance anxiety often rears its head in men over 50. The core concept of ‘having sex’ should be changed to making love! This shift in perception will make a big difference to how men approach middle age. Men must learn to relax, increase intimacy with their partners (what women really want in any case!), and not be focused on the ultimate goal, but rather on the process: making gentle, meaningful, intimate love, even without intercourse. There are of course, physical, mental and emotional issues to consider when libido lags, or impotence wanes, and sense of wellbeing and vitality disappear for long periods. There are many options, from relaxation techniques, mental-emotional healing, to herbs that can help re-balance the male reproductive system.

Men are, just like women, often troubled by health conditions that are hormonal in origin and which implicate and affect the reproductive system.

prostate-healthEven though it’s quite small, the prostate gland frequently leads to health problems and is responsible for a large percentage of medical care costs in men over 40. The most common prostate problem is benign (i.e. not cancerous or malignant) enlargement or benign prostate hypertrophy (hyperplasia) (BPH). At least 50% of men over the age of 40 have enlarged prostate glands. By the time they reach 70, 80-90% of men have prostate enlargement. The prostate gradually enlarges with age due to the repeated stimulation of testosterone and dihidrotestosterone. As it enlarges, it progressively encloses the urethra. As the compression of the urethra increases, the bladder is unable to empty completely, the outflow of urine is impeded and bladder infections become a frequent occurrence. Urine that stays inside the bladder is an ideal growth medium for bacteria. 

The symptoms of BPH are due to the increasing obstruction of the urethra by the enlarging prostate gland, leading to a restriction in the outflow of urine. Early symptoms may simply be a decrease in the size and force of the urine stream. With mild BPH, the peak flow is 15-20 ml per second (normal outflow would be 20ml per second). With moderate BPH the rate drops to 10-15ml per second and with severe BPH, it drops to below 10ml per second.

Prostate problems are often without pain, but when pain does occur due to the prostate gland it is usually felt over the bladder during urination or around the anus. Anal pain may occur after ejaculation. Sometimes the prostate gland refers pain to the lower back but this is not usual with the most common prostate problem, benign prostatic hyperplasia or benign prostatic hypertrophy.

Other symptoms include difficulty in starting to urinate (hesitancy). The hesitancy requires some straining to start the urine flowing. Because of the obstruction of the urethra, the bladder doesn’t empty properly and residual urine stays behind in the bladder. This retention of urine causes a sensation of incomplete emptying – another symptom of BPH. The residual urine (stasis of urine) is also an ideal breeding ground for bacteria leading to bladder infections. Bladder infections (cystitis) in men always need a thorough examination of renal (kidney) and bladder function.

BPH is often just a nuisance, interfering with quality of life and disturbing normal sleep. It rarely improves spontaneously, usually either remaining the same for years, or gradually getting worse.

Prostatitis is another frequent prostate problem, especially in younger men. The prostate becomes inflamed as a result of infection with bacteria or viruses. Symptoms of prostatitis include localised pain, pain in the anus, sometimes while ejaculating and burning while urinating (dysuria).

Prostate cancer is the third most common cancer in men. Only lung and colorectal cancers rank higher in terms of incidence and morbidity. A study published in the Journal of the National Cancer Institute reported that men who consumed more than 30 grams of saturated fat a day (mostly from meat and dairy products) had twice the risk of prostate cancer than men who ate less than 11 grams of saturated fat a day. No other dietary factor has been shown to have such a significant correlation with prostate cancer. The authors of the study recommended that men try to eat 10 grams or less of saturated fat a day as a preventative measure. Researchers from the University of Massachusetts Medical School reported that diets relatively high in meat, milk and poultry seem to lead to a greater incidence of prostate cancer than those consisting of grains, nuts, fish and soy. 

There is probably also a correlation between a low fibre diet and prostate cancer. Sufficient dietary intake of fibre may prove to be beneficial for preventing prostate cancer, as is also the case in other forms of cancer such as breast and colon cancer

Nutrition: deficiencies of certain nutrients (such as amino acids, zinc and B-vitamins) as well as excess intake of others (such as a diet high in saturated animal fat), also plays a role.

Symptoms of benign prostate hypertrophy (BPH)

  • Nocturnal urination (nocturia)
  • Frequency of urination (often having to urinate, especially at night)
  • Urgency (the need to go immediately) to urinate
  • Dribbling after urination
  • Weak stream
  • Painful urination (dysuria).
  • Men with enlarged prostates often have to get up 2-6 times a night to urinate. This is a distressing symptom leading to sleep disturbances. The night time urination is due to the residual urine, irritation of the urethra and changes in kidney (renal) function.

If you have any of the above symptoms, you have to go for a general examination which would include a rectal examination, urine analysis (to diagnose bladder or kidney infection), full blood count, PSA test (blood test for estimation of the quantity of prostate specific antigen, but do not overestimate its accuracy). The enlarged prostate can be felt on rectal examination as a soft, smooth, regular enlargement. The PSA can be normal or slightly increased in BPH. A very high PSA is indicative (not absolutely diagnostic) of cancer and further tests will be done. The prostate is usually small, hard and shrunken with nodules and irregular lumps when cancer is present. This can be felt during a routine rectal examination. A man would thus not present with the usual symptoms of BPH. Prostate cancer is most often diagnosed when metastases to the bone have already occurred. That is why it is important for all men over the age of 40 to go for regular medical check-ups (once a year) which would include a rectal examination.

An ultrasound test of the prostate can also help with the diagnosis which can often be difficult to make. For example, hard cancerous nodules can be hidden inside a soft, enlarged prostate. A biopsy of the prostate gland can also be done if the diagnosis is uncertain. 

A few years ago, surgical removal of the prostate was the only option when the symptoms became intolerable. Prostate surgery (transurethral resection of the prostate or TURP) is still considered the treatment of choice by many urologists. Prostate surgery carries its own risks such as possible perforation of the bladder, infection, hemorrhage, persistent urinary incontinence and even permanent impotency. Surgery is also not always effective.

The conventional prescription medicines like finasteride and doxazosin often have unpleasant side effects. Herbal remedies, like Saw Palmetto (Serenoa repens), stinging nettle and Pygeum africanum, have been proven in various randomised, double-blind placebo controlled trials to be as, or even more, effective in the prevention and treatment of BPH and other urinary tract problems as the usual prescription medicines.

Natural food supplements and herbs to support prostate health

  • Herbal remedies: saw palmetto, Pygeum Africanum, stinging nettle, garlic, turmeric, ginger, and rosemary, green tea, pumpkin seeds
  • Amino acids: alanine, glycine, glutamic acid
  • Nutrients: lycopene (in red tomatoes), fruits like guavas, watermelon, and pink grapefruit, zinc

The usual healthy lifestyle prescription also applies for the optimal health of the male reproductive system and a general sense of wellbeing of body, mind, emotions and soul. These are correct eating habits (regular meals with lots of fruit and vegetables, low in saturated fats, high in whole grains, legumes, nuts and seeds – especially ripe or cooked tomatoes and pumpkin seeds are excellent for prostate health), practicing safe sex (preferably rather making love!), stress management, deep relaxation practice every day, 30 minutes of moderate exercise 5 times a week, 8 glasses of water a day and the right food supplements. Mental-emotional healing, once the diagnosis of prostate or testicular cancer is made, is of the utmost importance to assist patients in moving beyond fear. Fear is the real problem, and learning to connect to a deep inner source of healing and love, is the solution. 

Nutritional therapies, such as vitamins, minerals, amino acids and botanical herbal supplements, are becoming more and more popular for the treatment of prevailing health problems due to their gentler effect on the body, the fact that they are generally safer to use, are less invasive and also more cost effective.

Zinc supplements have also been shown to improve urinary symptoms and reduce the size of the prostate in men with BPH.

Research has shown that Pygeum africanum and nettle root (stinging nettle) partially block the action of 2 enzymes involved in the conversion of testosterone to dihydrotestosterone and estrogen. Elevated levels of these hormones are strongly implicated in BPH.  Pygeum africanum is an evergreen tree that grows in Africa. The bark of the tree has been used for years by natives of tropical Africa to treat urinary disorders.

Pumpkin seeds are rich in zinc and phytosterols that strengthen cell membranes. The phytosterols (one of which is beta-sitosterol) found in pumpkin seeds and Pygeum africanum, improve male hormone and prostate function. The triterpenes in Pygeum reduces swelling of the prostate and the ferulic esthers reduces prolactin secretion as well as accumulation of cholesterol, both implicated in BPH. Prolactin increases the prostate’s uptake of dihydrotestosterone and cholesterol increases the binding sites for dihydrotestosterone in the prostate gland.

Did you know

  • Relationships, strong family ties and friendships are able to play a protective role against the development of diseases of the heart and the sexual organs?
  • Forgiveness can prevent a 2nd heart attack?
  • Writing or talking about a traumatic experience can significantly improve one’s health status?
  • Smoking may lead to impotence?
  • Optimism can be learned and exerts a positive effect on health and wellbeing?
  • Meditation, eliciting the relaxation response, significantly reduces the risk of developing disease while also reversing ageing and increasing longevity?
  • 80% of all deaths are directly caused by preventable diseases?