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#GatekeepersofMen

Episode 11

News & Events

Treatment Options for Prostate Cancer

Prostate Cancer Treatment Options

The purpose of the Movember movement is to create awareness among MEN and women regarding prostate cancer. I want to emphasize how important it is for men to go to their urologist and get their prostates checked.  We all know women tend to be more responsible than their male counterparts when it comes to their medical care and health.   Why?   Us Men feel we are invincible, strong, machos, heroes, the main character in the movie, and silverback gorillas. However, it isn’t until we start feeling very sick or have multiple problems, that we decide to go to the doctor.

Prostate cancer is CURABLE! 

One out of 9 men will be diagnosed with prostate cancer. If you are African American or have family history of prostate cancer, that risk is even higher!  Nevertheless, when the cancer is detected early, it can be CURED.   You read it correctly. Prostate cancer is CURABLE! 

Today I wish to discuss the various treatment options we have available when men are diagnosed with prostate cancer.  Which treatment option will be best for will depend on the aggressiveness of the cancer, urinary symptoms, and other health factors or comorbidities.

 

Active Surveillance for Prostate Cancer

This option is good for patients who have a less aggressive cancer, or what urologists call “low risk or very low risk”.  Some men on active surveillance may not need treatment, ever.  During active surveillance, the patient follows up periodically with certain blood tests, rectal exam, and imaging studies along with repeat biopsies to actively monitor any progression of the cancer.  If it progresses to a ‘higher risk’, the doctor treats the cancer.

Surgery for Prostate Cancer

Surgery involves removing the prostate gland (called radical prostatectomy). Nowadays, the vast majority of urologic surgeons do this surgery with the assistance of a robot.  Men who decide to undergo surgery carry a risk of developing urinary incontinence, or leakage of urine, along with erectile dysfunction.

What are the advantages?

  1. The surgeon takes the entire prostate out.  If the cancer is localized or contained inside the prostate, you walk out of the operating room FREE OF CANCER.  It is a one-time deal.  You go in to the OR, you get out, and it’s over.
  2. The surgeon removes the prostate and a pathologist will analyze it under the microscope to determine the extent, location and grade of the cancer.
  3. If the patient has bothersome urinary symptoms with obstruction: taking the prostate out will solve this problem.
  4. Your urologist will be able to monitor for possible recurrence better. Why?  When the prostate is removed, the PSA test will become undetectable within 6 weeks.  Given that the PSA, in some cases, may never become undetectable after radiation, this test can be less reliable.

What are the disadvantages?

  1. The possibility of long-lasting bladder control problems.  For men below 65 years old, approximately 5% will have significant urinary leakage.  (the risk with Radiation is 1-2%).
  2. Erectile dysfunction can occur in approximately 60% of patients.

Radiation for Prostate Cancer

Radiation uses high potency x-rays that will kill the cancer cells.  There are different ways a doctor can apply the radiation.  Radiation can also cause problems with urine control and erectile dysfunction.

What are the advantages?

  1. It is easier to undergo than surgery.  Recovery from surgery is usually 1 to 3 weeks, whereas recovery from radioactive seed implantation is 1-2 days.  For patients who choose radiation, most will also undergo daily external beam treatments for 6 to 7 weeks. However there are no incisions, no cuts, and most of the time, no pain.
  2. Risk of poor bladder control is significantly less (1-2%).
  3. Risk of erectile dysfunction is lower than surgery, approximating 20 to 40%.

What are the disadvantages?

  1. Some patients can experience difficulty emptying the bladder.  So if you experience frequent urination and decreased force of the urinary flow, the likelihood of long-lasting symptoms following radiation therapy increases.
  2. Some of the side effects can occur many years after treatment. These include bleeding in the urine and bleeding stools, although these are rare.

So which one should I choose?

The most important thing you need to know is that cure rates approximate 98% with BOTH surgery and radiation. Urologists offer both treatments for patients who have their cancer limited within the prostate.  Surgery is dependent on ONE factor to be successful:  location of the cancer.  If it is contained within the prostate gland, it cannot return following removal.  With radiation, 3 things must happen:

  1. The cancer must be confined to the treatment area.
  2. Cancer cells must respond by DYING.
  3. The entire normal portion of the prostate must “die” to eliminate the future source of prostate cancer. 

In Conclusion…  

The take home message for today’s #GatekeepersofMen post is: if you are a male above 50 years old, go see a urologist and get your prostate checked.  We want you to live worry-free. If the doctor finds cancer and it is still contained within the prostate without signs of spreading, you can be CURED.

How often can we associate the word CANCER with a CURE? That is Movember’s purpose.  Screen for cancer, help you learn about the treatment options for prostate cancer, and (if present) cure it and let you live a longer life, cancer free. 


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

Movember and Prostate Cancer Awareness

Movember

Time to create Awareness of Men’s Health Issues!

Movember (from the Australian-English diminutive word for mustache , “mo”, and “November”) is an annual movement involving growing of moustaches during the month of November to create awareness of men’s health related issues including Prostate Cancer, Testicular Cancer, Men’s Health and suicide prevention.

Therefore, I have decided to dedicate this month’s #GatekeepersofMen series to the Movember movement.  Let’s start off with Prostate Cancer.

 

How common is prostate cancer?

Prostate cancer is the second most common cancer in men (skin cancer being the most common).  The American Cancer Society estimates that about 1 out of 9 men will be diagnosed with the disease during his lifetime.   That number is staggering!  Think about it, if you are in a get-together event with 8 of your male friends, one of you will be diagnosed with prostate cancer!

Moreover, older men and African-American men have a higher risk of developing cancer in their prostate.  60% of cases are diagnosed in men older than 65 years old, and it is extremely rare for men under 40 to be diagnosed.  Regarding race: 1 of every 6 African-American men develop prostate cancer. 

Who is at risk?

  1. Age: The risk of developing prostate cancer increases with age.  This is why we encourage men older than 50 years old to ask their doctors about screening. 
  2. Family History: If someone in your family (brother, father or son) was diagnosed with prostate cancer you have a 2 to 3 times higher risk of developing the disease.
  3. Race: Studies show that African American are at higher risk of developing prostate cancer.
  4. Smoking: Just as with other cancers, smoking increases your risk of developing prostate cancer.

What are the symptoms of prostate cancer?

Unfortunately, not everyone experiences symptoms. Many of the “signs and symptoms”  coincide with BPH and these include:

  • Urinary frequency, especially during the night
  • Difficulty starting urination
  • Difficulty holding the urge to urinate
  • Weak stream
  • Blood in the urine or semen

One symptom: frequent pain of the lower back, hips or upper thighs, could be an indication that the cancer is already spreading. Therefore, it is crucial that us men start the screening process when indicated.

What does Prostate Cancer Screening involve?

  1. PSA test:  PSA stands for prostate specific antigen. PSA is a chemical that ONLY the prostate produces into the bloodstream.  When PSA is found elevated in a blood test, it indicates that there is increased activity of the prostate. In some occasions, that increased activity may indicate that there is uncontrolled cell growth which means, cancer is growing.
  2. DRE:  DRE stands for digital rectal exam.  Yes. It is a necessary tool that urologists use to help detect the presence and aggressiveness of prostate cancer even though nobody likes this test.  Why?  Not all prostate cancers show an elevated PSA. Therefore, we don’t want to miss a cancer that may be growing even when the PSA is within normal limits.

When should I start screening?

The most common question that I receive from friends, family, and patients is: when do I need to start screening for prostate cancer? Basically, if you are a MALE above 50, talk to your doctor about screening.  Most importantly, if you are African American or have family history of men with cancer in their prostate, you should consider screening starting at 45 years old.

In Conclusion…  

 If you are a male above 50 years old, are African-American or have a family member with history of prostate cancer, you should visit a urologist.  Early detection is key!  Studies show that more than 98% of prostate cancers are curable if detected and treated early.   If it is detected late, the chance of survival beyond 5 years can be as low as 26%.  

In our next post I will be talking about how prostate cancer can be treated. If you are looking for a urologist, come visit us.  We are eager to meet you and help you retake the reigns of your life.  You are in control!


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

Dr. Clavell presents at SMSNA National Conference

Dr. Clavell was invited as faculty for the 2019 Sexual Medicine Society of North America (SMSNA) Annual Meeting in Nashville, TN. He was invited to share his experience as an expert in the field of Peyronie’s Disease and Men’s Sexual Health. His lecture was on the Management of Complications after Xiaflex injections and Surgery for Peyronie’s Disease.   

He also contributed to 5 research studies presented at the meeting! 

 

El Dr. Clavell fue uno de los profesores invitados a la Conferencia Anual (2019) de la Sociedad Norteamericana de Medicina Sexual (SMSNA, por sus siglas en inglés) en Nashville, TN. El fue invitado para compartir su experiencia como experto en el campo de la enfermedad de Peyronie’s y Salud Masculina. Su presentación fue sobre el Manejo de Complicaciones luego de inyecciones de Xiaflex y Cirugías para la enfermedad de Peyronie’s

Él también contribuyó en 5 estudios de investigación que fueron presentados en la conferencia este año! 

 

 

What to know when considering surgery for BPH

Considering Surgery for your Enlarged Prostate?

Over the past decade, urologists and men with obstructing urinary symptoms secondary to BPH have been introduced to a number of surgical alternatives for managing this condition. 

Men who suffer from BPH on certain occasions become “slaves” of their bladders.  You wake up 2 or 4 times a night to go urinate. Everywhere you go the first thing you look for is the restroom.  You enter a mall and as soon as you open the door, you ask yourself or your partner “Where’s the restroom?”.   Some have managed to keep a urinal in their cars/trucks and they just relief themselves while driving.   And others just realize they have issues when they listen to younger people urinating beside them in a rest room and realize how strong the other person’s stream is in comparison to theirs.    If you have encountered any of these issues, I’ve got news for you…  you will benefit from seeing a urologist.

Middle Aged Man

 

BPH is a prevalent disease affecting approximately 50% of men older than 50 years old and up to 90% of men after the age of 85.  Doctors may give you recommendations on lifestyle modifications like ‘stop fluid intake 2 hours before you go to sleep’. Others might prescribe you oral medications. But the big question remains….

 

How do I know if I need surgical treatment?

There are many factors that need to be considered in order to know if and what type of surgical management will be of benefit.  These are:  

1.     The size of the prostate: There are different treatment options that can be offered depending on whether the prostate is relatively small or very large

2.     The shape of the prostate:  Every prostate have two lateral lobes. However, some men develop an additional median lobe that protrudes into the the bladder and may increase the complexity of a given procedure.

Enlarged Prostate Diagram

3.     Presence of complications: if you are having complications that can potentially affect your overall health, you need surgical management.

4.     The degree of bother:  you can have a ‘huge’ prostate but if you have no complications and are not bothered, you do not need surgical treatment. On the other hand, if you have bothersome symptoms you will benefit from a procedure

When should I call a specialist? 

Every week we have more and more patients with BPH asking for less invasive procedures and expect the same outcomes as the more ‘classic’ alternatives.  Some have more or less side effects and a more rapid return to their “pre-procedure” daily activities.  Now we even have procedures that are minimally-invasive and can be performed in the office without the need of hospitalization or general anesthesia!

If you suffer from obstructing urinary symptoms and wish to be evaluated by a specialist, start oral medications, or finally be able to stop medications once and for all, we invite you to call our office and schedule an appointment. If you want to hear more about the surgical or procedure options that are available for you, call us! Our goal is to guide you through your journey towards a healthier lifestyle and an improved quality of life. 


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

La Bombita: Las 10 preguntas más comunes

Septiembre es el Mes de Crear Conciencia sobre la Salud Sexual

Para aquellos que han seguido mis artículos más recientes, por el pasado mes me he enfocado en tópicos relacionados a la Salud Sexual. ¿Por qué? Septiembre es el mes para crear consciencia sobre la Salud Sexual.  Por esta razón, siendo un experto en el campo de la Medicina Sexual y Salud Masculina, deseo poder ayudarlo a usted a optimizar ese aspecto tan importante de su vida.  Por lo tanto, hoy estaré compartiendo información acerca de un tratamiento sumamente importante que muchos hombres no conocen.  Hoy contestaremos las 10 preguntas más comunes sobre el implante de pene, comunmente conocido como “La Bombita”

Todas las semanas llegan hombres que han batallado con disfunción eréctil por muchos años.  Algunos han sufrido por más de una década y han intentado todo tipo de tratamiento. Esto incluye pastillas (Viagra, Cialis, Levitra, etc.), inyecciones en el pene, terapia de vacío (vacuum pump) y supositorios introducidos en la uretra.  Otros han gastado miles de dólares en tratamientos no-aprobados como la terapia de shock, o inyecciones de plasma y células madres.  Sin embargo, muchos hombres simplemente NO SABEN de los beneficios que provee lo que se ha demostrado ser el mejor tratamiento para la impotencia: el implante de pene. 

 

1. ¿Qué es un implante de pene?

El implante de pene (“la bombita”) es un dispositivo médico que se pone DENTRO del pene del hombre a través de una incisión pequeña. El implante le permite al hombre que sufre de disfunción eréctil (o impotencia) tener una erección firme y exitosa CADA VEZ que el hombre la desee. Con el implante de pene, no se necesitan pastillas ni inyecciones.  La bombita le pone fin a toda incertidumbre, decepción y frustración relacionada a una erección.  Los estudios de investigación demuestran que 95% de los hombres con el implante de pene están satisfechos con el tratamiento. 

2. ¿Cómo sé si soy un buen candidato para el implante de pene?

Si usted sufre de disfunción eréctil que no responde a medicamentos orales, usted es un candidato para la cirugía.  Algunos cirujanos lo consideran la bombita como el tratamiento de “última opción”. Sin embargo, los expertos en el campo de la medicina sexual están de acuerdo que NO se debería considerar como la última opción.  ¿Por qué? Sencillo… !Funciona! Los hombres que tienen un implante de pene (y sus parejas) están felices. 

3. ¿Cómo el doctor determina cuál es el mejor tipo de implante para mi?

Para contestar esta pregunta, usted debe saber que hay diferentes tipos de implantes.  El implante de pene inflable (IPP, por sus siglas en inglés) es el implante que más comúnmente se usa. Este implante le provee al hombre mantener una erección fuerte durante el acto sexual y tener el pene flácido o “suave” el resto del día.  Los implantes maleables (semi-rígido) usualmente se utilizan en hombres que no tienen la habilidad de apretar ‘la bombita’ que infla el implante de pene. 

Es importante notar que hay diferentes tipos de implantes inflables producidas for 2 compañías. Muchos doctores solo usan el implante de una compañía. Sin embargo, yo utilizo el implante de ambas compañías.  Yo examinaré su anatomía y así determinaré que tipo de implante será mejor para usted.  Yo también discutiré los beneficios de todos los tipos de implante.  Así, juntos determinaremos cuál será su mejor opción.  Mi meta es proveerle a usted con el mejor resultado para que su pene se vea natural.   

4. ¿Y en cuanto al tamaño, será menos largo de lo que tengo ahora? 

No. Usted no debe perder tamaño con el implante de pene. Sin embargo, usted debe de entender que la disfunción eréctil puede causar que su pene pierda tamaño y esto puede limitar el tamaño del implante de pene que se podrá introducir.  Yo mediré su pene desde la punta hasta abajo hacia el hueso durante su cirugía.  Yo le garantizo que le pondremos el implante más grande que su pene permita.  

Mire un Video de cómo se determina el tamaño de La Bombita


5. ¿ El implante afectará como se ve o siente mi pene? ¿Es algo incómodo?

Las primeras semanas luego de su cirugía, usted sentirá incomodidad y un poco de dolor.  Ese dolor e incomodidad mejorarán una vez usted sane.  El implante de pene será invisible. Nadie podrá saber o notar que usted tiene un implante al menos que usted se lo diga, incluyendo a su pareja.  La sensación del pene NO será afectada.  Adicionalmente, usted logrará obtener un orgasmo sin problemas. 

 

6. ¿ Y mi pareja? ¿Que va sentir ella? 

Una de las mayores ventajas del implante de pene es la satisfacción de la pareja. ¿Por qué? Su pareja sentirá una erección FIRME y NATURAL. Su pareja no podrá determinar la diferencia entre una erección natural y una erección con el implante peneano. El implante de pene le proveerá a usted lo más cercano a una erección ‘espontánea’.  Usted no tendrá que esperar 30 minutos a que un medicamento funcione. En cuestión de 30 segundos, usted podrá obtener su erección.  Adicionalmente, aún si usted tiene un orgasmo rápido, su pene se mantendrá firme hasta que su pareja este completamente satisfecha.  Piense esto: SIEMPRE que su pareja quiera tener sexo, usted podrá satisfacerla. 

 

7. ¿Puedo hacer ejercicios con el implante?

Usted tendrá un poco de dolor durante las primeras semanas luego de su cirugía.  Usted debe de limitar la cantidad de ejercicios y levantamiento de objetos pesados durante las primeras 4 a 6 semanas.    Sin embargo, luego de su cita post-operatoria, usted podrá hacer cualquier tipo de ejercicios sin límites. Usted podrá brincar, caminar, correr, levantar pesas, correr bicicleta, etc. 

8. ¿ Cuáles son los riesgos? 

El riesgo más común del procedimiento es infección.  Sin embargo, este riesgo es bien bajo en manos de un cirujano con experiencia haciendo el procedimiento. Muchos hombres preguntan si su cuerpo rechazará el implante.  La respuesta es que no.  Su cuerpo no rechazará y no creará anticuerpos ni alergias contra el implante. 

9. ¿Cuánto cuesta ‘la bombita’? ¿Es caro el procedimiento?

Tengo excelentes noticias para usted. La mayoría de los seguros médicos CUBREN LOS GASTOS de la cirugía. Si su seguro médico no lo cubre, trabajaremos con usted para conseguirle cubierta.  Para aquellos que no tiene seguro médico y lo pagan a costo:  ¡nuestra oficina tiene uno de los mejores precios en la ciudad y en los Estados Unidos! 

10. ¿Por cuánto tiempo dura el implante de pene?

La bombita (o implante de pene) es uno de los mejores dispositivos médicos que tenemos en el campo de la medicina.  ¡Los estudios de investigación demuestran que la mayoría de los implantes de pene duran más de 15 años!

Si usted sufre de disfunción eréctil y piensa que la bombita es una opción para usted, llame a nuestra oficina hoy y haga una cita.  Su habilidad de obtener y mantener una erección NO debería causar que la relación con su pareja se vea afectada.  Mi mensaje para usted en el Mes de Cobrar Conciencia sobre la Salud Masculina es que en cuanto al sexo.. ¡no tiene que rendirse, no importa su edad! Hay soluciones APROBADAS y REALES que pueden ayudarlo a recuperar su masculilnidad. Llámenos. Para mi sería un honor poder ayudarlo.


Este artículo fue escrito por el Dr. Jonathan Clavell.  El Dr. Clavell es urólogo con especialidad en Salud Masculina incluyendo disfunción eréctil, testosterona baja, enfermedad de Peyronie’s, y BPH (prostata agrandada).

¿Por qué Gatekeepers of Men? 

Penile Implant: 10 Most Common Questions

September is Sexual Health Awareness Month

Lea el Artículo En Español


For those of you who have been following my most recent posts, this month I have focused on topics related to Sexual Health.  Why?  September is Awareness Month for Sexual Health. And, as an expert in the field of Sexual Medicine and Men’s Health, I wish to help you optimize that very important aspect of your life.  Therefore, today I wish to talk about a very important therapy not many men know or talk about.  I will address the 10 most common questions regarding the penile implant or prosthesis

Every week I see men with long-standing erectile dysfunction. They have suffered with their erections for years and have tried all sorts of treatments.  These include oral pills (Viagra, Cialis, Levitra, etc), penile injections, vacuum therapy, and urethral (Muse) suppositories. Some have even spent thousands of dollars on unproven treatments such as shockwave therapy and stem cell/plasma rich protein (PRP) shots.  However, many men do not know the benefits of the treatment option that has been proven to be the most effective therapy for ED: the penile implant.  

Happy Couple with Drinks

 

1. What is a penile prosthesis or implant?

The penile prosthesis is a device that is placed INSIDE the penis through a very small opening. It helps a man with ED be able to have an erection EVERY TIME he wishes to.  No more pills, no more injections, no more uncertainty, deception or frustration.  Research has shown that more than 95% of men who have a penile implant are satisfied with it. 

2. How do I know if I am a candidate for the penile implant?

If you have erectile dysfunction that is not responding to oral medications, you are a candidate for the penile implant.  There are surgeons that consider it as a “last resort”. However, experts in the field of sexual medicine agree that it should NOT be considered the last resort. Why? Simple.  It works!  Men (and their partners) are happy.

3. How does the doctor determine which type of implant is right for me?

To answer this question, you must know that there are different types of implants. The inflatable penile implant (IPP) is the most commonly used implant.  It gives a man the ability to keep their penis hard during sex, and the penis soft when not having sex. Malleable (semi-rigid) implants are usually reserved for guys who will not be able to squeeze the pump to inflate the implant.  

There are different types of inflatable implants as well. Although many doctors stick to using implants from one manufacturer, I use both manufacturers. I will determine which type is best for you depending on your specific anatomy. I will also discuss the benefits of all types, and this way, we will decide together which one is best for you. My goal is to provide you with the most natural outcome possible.

4. What about size? Will I lose length?

No. You should not lose length with the penile implant. However, erectile dysfunction can cause your penis to get smaller which may limit the size of the penile implant. During your surgery, I will measure the penis from the tip of the penis down to the bone.  One thing is guaranteed:  I will put in the biggest implant your penis will tolerate.

Watch video on How Size is Determined during Surgery


5. Will the implant affect how my penis looks or feels?  Is it uncomfortable?

The first few weeks after surgery, you will be uncomfortable and sore. But once you heal, those will go away. The penile implant will be invisible.  Nobody will be able to tell that you have the implant unless you tell them, not even your partner.  The sensation in your penis will NOT be affected. Additionally, you will still be able to reach orgasm. 

6. How about my partner? What will she feel?

One of the major advantages of the penile implant is partner satisfaction.  Why? Your partner will feel a natural and firm erection.  Your partner will not be able to tell the difference between a natural erection and one with a penile implant.  The penile implant provides for a close to ‘spontaneous’ erection.  You do not need to wait 30 minutes for a medication to kick in.  Within 30 seconds, you will be able to gain an erection.  In addition to this, even if you reach orgasm early, your penis will stay hard until your partner is fully satisfied. Think of it this way:  every single time your partner wishes to have sex, you will be able to fully satisfy her/him. 

Happy Couple

7. Can I exercise with it?

You will be sore in your penis and scrotum the first few weeks after your surgery.  During those first 4 to 6 weeks you should limit exercise and weight-lifting.  However, after your postoperative visit you should be able to exercise without limitations.  You will be able to walk, run, lift weights, ride a bike, hike, etc.

8. What are the risks?

The most common risk of the procedure is infection.  However, that risk is very low when the surgery is performed by a skilled surgeon.  Many men also ask if their bodies will reject the implant.  The clear answer is no.  Your body will not reject the implant and you will not be allergic to it. 

9. Is the penile implant expensive? 

I have great news for you!  Most major insurances cover the expenses of the surgery.  If your insurance does not cover it, we will work with you to try to get coverage. 

10. How long does the penile implant last?

The penile implant is one of the best medical devices we have in medicine.  Studies show that most penile implants last more than 15 years!

If you have erectile dysfunction and wonder if the penile implant is right for you, call our office today and book an appointment. Your relationship should not be affected because of your ability to maintain an erection. My message to you on this Sexual Health Awareness Month is that no matter your age… you do not have to quit on sex.   There are REAL and PROVEN solutions that can help you restore your manhood.  Call us. We will be honored to help you.


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

Hey Man, Are you to blame?

Hey Man, Are you to blame?

September is Sexual Health Awareness Month. 

I recently ran into an article published at the NY Times titled “Why a Woman’s Sex Life Declines After Menopause”.

What really caught my attention was the second part of the title “Hint: Sometimes It’s Her Partner”.    Now,  if you are a man above 45 years old, and you are reading this, get ready! This post will create a PARADIGM SHIFT in your relationship and attitude towards not only your partner and sexual health, but your OVERALL HEALTH.    Yes, believe it or not, research proves that sex is a reflection of your mental, cardiovascular and overall health.

In the article the author referenced new research that revealed that “…often, it’s the health of a woman’s partner that determines whether she remains sexually active and satisfied with her sex life.”

What does Research show? 

The research study surveyed more than 24,000 heterosexual women with ages between 50 to 74 years old.  The most interesting part was that more than 4,000 women wrote comments. This gave researchers more insight to the root of the cause.   Although the most common reason for a decline in sexual intimacy was death or divorce (37%),  (male) partner’s health related-reasons were shockingly high.  

  • 23% said the lack of sex was because of their partner’s physical problems.
  • 21% of women said their partners had lost interest in sex
  • 8% said their partner was too tired for sex

Happy Couple

 

That’s MORE THAN HALF of the time sex decline was not because of her, but because of the male partner in the relationship.

 

Here are some of the quoted comments in the study:

He does not maintain erection strong enough for penetration (after prostate surgery and diabetes). My sexual activity was limited by what my husband’s health is.” (Age 59)

My husband had a stroke which left him paralyzed and now sex is too difficult.” (Age 52).

 “He drinks approximately 1 to 1.5 bottles of whiskey a day. Sex is once or twice a year.” (Age 56)

Only have sex twice a year maybe. My partner has lost his libido and never thinks of it, although he loves me and worries about it.” (Age 60)

If you have read my previous posts I am sure you are able to notice the common theme here:  low libido, poor physical health, lack of interest, too tired:  it all screams LOW TESTOSTERONE

 

Now you might wonder where I’m going with this..  

Simple:  you, as a man, don’t have control of many things. But one thing you do have control of is your body.   Strokes, heart disease, diabetes, alcoholism, are all things you can prevent.  If you are young and sexually active, pay attention! Don’t let your health be the reason your wife/partner’s sex life declines.  And if you are reading this and think I am “preaching to the choir” and know you are part of the reason the intimacy in your relationship has declined,  re-take the reigns.   Get up, exercise, control your diabetes, take your blood pressure medications.  Your life (and your penis) depend on it. Talk to your partner and look for help.  There are experts that can help you both.

If you suffer from erectile dysfunction or low testosterone, call our office. We have all the tools to help restore your sexual health. We would be honored to be able to help you.  Our goal is to guide you towards a healthier lifestyle.


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

When “Not Lasting Long Enough” is the Problem

Should you be able to “last longer” in bed?

I recently saw an article published in a well-known Men’s magazine which mentioned that one of the most common Googled questions about sex was “how to last longer in bed” with more than 60,000 searches per MONTH.  Suddenly, I knew I had to write about this since there are many things that men should have clear and know.  

Premature ejaculation is a very common concern among men.

 

Even more so, premature ejaculation (PE) is considered the most common sexual dysfunction in men.   Once considered to be purely psychological (meaning: all in your head) that could only be treated with behavioral therapy or crude attempts to decrease sexual stimulation, upcoming research has shown that this condition is far more complex than we originally knew (so.. it’s not all in your head).

Man Having Premature Ejaculation Problems

But,  how long should I last?

There are many definitions and categories for PE.  For example, in 1970 Masters and Johnson stated that “too quick” meant when a man was unable to satisfy the partner to reach orgasm in less than 50% of intercourse attempts.   This was obviously criticized since it was dependent on the partner’s ability or inability to reach sexual pleasure.   Then other researchers came up with the term ‘Intravaginal Ejaculatory Latency Time” (IELT) and found that the average amount of minutes that men were able “to last” was about 7 minutes.  On the other hand, those with PE lasted an average of 2 minutes. 

What are the different categories of PE?

Premature ejaculation can be:

  1. Primary:  or life-long (a man who has always had the problem)
  2. Secondary:  a man who acquires the problem later in life.  (Mostly associated with Erectile Dysfunction)

These first two are the more common classifications since the following two categories are still under scrutiny given the lack of research data on the topic.

  1. Psychogenic (or psychologic):  These men tend to respond to psychological or behavioral therapy (i.e. sex therapy)
  2. Biogenic: men who do NOT respond to behavioral therapy.

How do I know if I have premature ejaculation?  What are the signs of PE?

It is important to note that PE is a self-reported diagnosis.   The only way a doctor can know about this is if the patient tells him/her.   These men usually report:

  1. Report problems maintaining an erection (erectile dysfunction)
  2. Say they are unable “to last” long enough
  3. Report desire for treatment and resolution of the problem
  4. Show embarrassment or shame (which prevents them from asking for help).
  5. Tend to wait years before seeking medical advice.

When should I seek help? 

At the end of the day, PE is a real problem for those who suffer from it.  I’ve seen men in my practice that fear they might lose their marriage because of premature ejaculation. 

If you feel that the relationship with your partner is being affected because of “not lasting long enough”, you should seek care.  There are different ways a specialist can help you.  We encourage you to call our office for an appointment.  We will be honored to guide you through your journey towards an improved quality of life.


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

Penile Rehabilitation – Life After Prostate Cancer

The American Cancer Society estimates that 1 out of 7 men will be diagnosed with prostate cancer during his lifetime.  Nevertheless, 5-year survival rates after treatment of localized prostate cancer approximate 98%.   Yes, you read it correctly.  When diagnosed early and the cancer is still localized within the prostate, there is almost 100% chance you will be cured. 

How can prostate cancer be cured?

The most common treatment options are surgery and radiation, both of which are able to successfully treat the cancer.  Nowadays, most urologic surgeons use the assistance of a robot to remove the prostate through very small holes (laparoscopy).    This avoids a big incision and provides a smooth and quicker recovery.

So….  you are cured. Now what? 

Despite its efficacy in treating prostate cancer, surgery and radiation have been shown to affect erectile function and urinary continence, and hence, the patient’s quality of life.  Unfortunately, many men with history of prostate cancer find themselves trading their erections for a cure.  Overall, studies have shown that the incidence of ED after radical prostatectomy (surgery for prostate cancer) ranges between 14% and 90%. (1)  A study in 2015 looked at patient-reported outcomes of more than 2500 men and found that more than 70% of men had erectile dysfunction 1 year after surgery.

Happy Couple

 

What can I do if I developed ED after prostate cancer?

Rehabilitation is one of the foundations in medicine today for the successful recovery in multiple diseases.  And just as your leg goes through rehabilitation after a knee surgery, your penis should go through rehabilitation after prostate cancer surgery.  Yes, there is such a thing.  Now the key to a successful rehabilitation is to start as early as possible among other factors.

What to know about Penile Rehabilitation?

In order to know who has a better chance of regaining their sexual function back, there are several factors to consider:

  1. Preoperative erectile function:   research has shown that men who had normal erections prior to their surgery have a higher likelihood of recovering their erectile function after surgery.   Basically, if things were not working before surgery, it is unlikely they will work after surgery.
  2. Surgical technique:  Did the surgeon attempt to preserve your nerves, also called ‘nerve-sparing’ technique?  Was your surgery done with the assistance of a robot?  Research has shown that those who underwent nerve-sparing robotic-assisted surgery had a better recovery when compared to those undergoing open surgery.
  3. Timing since surgery:   As stated above, the key to a successful rehabilitation is to start as early as possible.   Those who start rehab weeks after the surgery have a higher likelihood of recovery than those starting 1 year or 2 years out. 

In Conclusion…

There is no standard algorithm for penile rehabilitation. However, we believe any rehabilitation is undeniably better than no action at all.  If you or anyone you know has undergone treatment for prostate cancer, there is a high likelihood you (or him) struggle with erectile dysfunction.  We encourage you to visit our office and hear out how we can help you.

Remember, there is LIFE after prostate cancer treatments. Our goal is to help you recover that quality of life back.


1.     Clavell-Hernandez J, Ermeç B, Kadıoğlu A, Wang R. The perplexity of penile rehabilitation following radical prostatectomy. Turk J Urol 2019;45(2):77-82.

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men? 

Five Most Common Complications Associated to BPH

How an Enlarged Prostate can affect your overall health

 

Benign prostatic hyperplasia, also known as BPH, is a prevalent condition that affects approximately 50% of men over 50 years old and up to 90% of men after the age of 85.  Many men with BPH have bothersome symptoms. Others, simply do not have bothersome symptoms, either because of lack of awareness or simply they just get used to them.  Every week I meet men in my office to whom I ask “How is your urination?”  and their response is “Normal for my age, I guess”.  Then, when I keep inquiring they have a wide array of issues and that is why I will focus today on BPH complications. 

Middle Aged Man

 

But… what happens to those that really don’t have bothersome symptoms? How do you know if you need your prostate checked? 

Sit back and read below because here I will discuss the 5 most common complications associated to an enlarged prostate:

 

1. Recurrent Urinary Tract Infections (UTIs)

To put it simply, Men are not supposed to be having bladder infections.  Infections in women most commonly happen because bacteria migrate from the vaginal canal into the bladder through a very short urethra.  

a.     Average Length of the female urethra:  about 2 inches

b.     Average Length of the male urethra:  about 8 inches.

Therefore, in men, it takes a loooong way for bacteria to get into the bladder from the outside.

When men develop bladder infections it is most likely because the urine gets trapped inside the bladder, sits there for a long time, and bacteria start growing on the inside. 

 

Urinary Tract Infection

2. Urinary Retention      

Inability to urinate, or urinary retention, is a medical emergency. The most common cause of urinary retention in men, is BPH.  The prostate grows to the point of preventing any urine from passing through.  If your prostate is preventing you from urinating, you need it treated sooner rather than later.

3. Gross Hematuria

Just as men are not supposed to have urinary tract infections (UTIs),  no-one, and I repeat: NO ONE,  is supposed to be seeing blood in the urine (hematuria), not even people taking blood thinners.  You might wonder:

Why does the prostate cause blood in the urine?   The prostate is an organ that is kept alive by blood vessels that bring blood and nutrients to it.  Just as when you were 20 years old you needed more food/nutrition than when you were 5 years old,  a bigger prostate will need more blood vessels in order to “stay alive”. Sometimes those tiny blood vessels can bleed and when you urinate, blood can be seen.

4. Bladder Stones

When we mentioned that Bladder infections occurred because of bacteria staying trapped inside the bladder…  well, now imagine that when the urine is unable to be emptied, that concentrated urine will crystallize, form tiny minerals and eventually form into stones.  Now, small bladder stones may pass without treatment, but sometimes bigger stones (like the one shown in the Xray below) need treatment as these may lead to infections and other complications that may include:

a.     Lower abdominal pain

b.     Pain during urination

c.      Frequent urination

d.     Difficulty urinating or interrupted urine flow

e.     Blood in the urine

 

Bladder Stones

5. Damage to Kidney Function

This is the most concerning of the BPH complications. If the prostate is blocking the opening of the bladder, urine starts backing up all the way up into the kidneys. Then the kidney swells due to urine failing to properly drain down into the bladder and cause a condition called hydronephrosis.  This can then lead to a decline in the kidneys’ function. And as you may already know, we need our kidneys healthy!

In Conclusion…

All these BPH ‘complications’ are strong indications that the prostate needs some sort of surgical management.  If you are experiencing any bothersome urinary symptoms or are having complications secondary to enlargement of the prostate, we encourage you to call our office for an appointment.  We will be honored to guide you through your journey towards a healthier lifestyle.


This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.  

Why Gatekeepers of Men?