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Hi everyone!

Have you chatted to your dad lately? Or perhaps you think of another prominent male as your paternal figure? Take a few minutes to send a text message, email or make a phone call to a special male in your life to let them know you’re thinking of them and appreciate them. Men appreciate affirmation as much as anyone else.

This article is about men’s health.

Men can be peculiar characters and often present because his “missus told him to”, or because his leg is falling off. In my experience when I see a new young man in my column I know they are there because either they are stressed about their job, they have a knee injury or there is something up with their genitals. For those who come for other reasons should always be asked – how is your mood going? Do you need an STI check?

I see anxiety and depression very commonly among males – young and old. The dominant worry tends to be about financial stressors and a sense of feeling trapped providing for their family when they are not feeling the best. Remember that young males are a risk category for suicide, so this is an opportunity to do everything you can to potentially save a life. Take the emotions serious, tell him you care and that you’d like to see him again on a regular basis to make sure things are going ok. Use the recurring appointments to complete a mental health care plan and refer him early to a psychologist for CBT.

Erectile dysfunction is common and should be treated seriously. It can cause an enormous amount of shame for the patient, and for them to bring it up in a consult takes courage. Take the time to set them at ease and normalise the situation – “it is a common problem, and I think you’d be surprised at how many men your age have a similar problem”. Remember that erectile dysfunction can be a side effect of their medication, or can be one of the first signs of metabolic diseases such as diabetes or hypercholesterolaemia. Complete the investigations for secondary causes before blindly prescribing sildenafil.

Be kind to yourself, and be kind to the men in your life as well!

Dr Andrew Harris
Director of Amadeus Education.


Did you know?

According to BEACH data, 2.4% of all encounters in General Practice were specifically related to the urological system, and 1.1% were related to the male genital system. Consider this as you are preparing for your exams. (Source: General practice activity in Australia: 2015-16. https://bit.ly/2c4d8Em)

Presenting complaints:

These are the common presenting complaints that should be covered for this topic:


Common conditions:

These are the common conditions that should be reviewed for this topic:

Topics

Important reading

Prostate disease – including cancer, BPH, prostatitis, phimosis

Penis issues – including phimosis, balanitis, circumcision

Sexual dysfunction – including erectile dysfunction

Scrotal/testicular issues – including lumps, cancer, testicular torsion

Hernia

Male infertility


Medication doses:

These are the medications and doses that should be learned for the exam:

Condition

Medication

Erectile dysfunction

Sildenafil 50mg orally, 1 hour before sexual activity

Prostatitis

Trimethoprim 300mg daily for 4 weeks

BPH

  • BPH

    • Tamsulosin (alpha blocker) – once daily OR

    • Prazosin (alpha blocker) OR a combo

    • Tamsulosin 400mcg /Dutasteride 500mcg (5 a-reductase inhibitor) – once


CHECKS:

Here are the list of recommended Checks that would be useful in your study for GP exams (accessed via subscription from http://gplearning.racgp.org.au):

  • Male reproductive system, April 2018
  • Sexual health, April 2017
  • Men’s health, October 2016
  • Men’s health, November 2013
  • Sexuality and sexual health, July 2013

Focus on clinical skills:

Here is a brief focus on some OSCE preparation topics related to this topic:

  • Engaging men in primary care settings. Andrology Australia, March 2018. (https://bit.ly/2NqfHyw)
  • Male genital examination: Step-by-step examination of male genitals and secondary sexual characteristics. Andrology Australia, March 2018. (https://bit.ly/2uEEKWs)
  • Childhood and adolescence: Examination of male genitals and secondary sexual characteristics. Andrology Australia, March 2018. (https://bit.ly/2JSBocN)
  • Adulthood: Examination of male genitals and secondary sexual characteristics. Andrology Australia, March 2018. (https://bit.ly/2OHfyI4)

Focus on medicolegal:

Here is a brief focus on the medicolegal issues covered in Australian Family Physician:

Copyright © 2021 Andrew Harris

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