We are picking up where we left off last week. Virility, prostate cancer, impotence, sexually transmitted diseases. Learn all about them and much more on this edition of Frank Relationships.
THE PROSTATE AND OTHER UROLOGICAL ISSUES
Guests: Dr. Chiledum Ahaghotu
Date: March 17, 2013
Frank: Virility, prostate cancer, impotence, sexually transmitted diseases, learn all about them and much more on this addition of Frank Relationships.
Welcome to Frank Relationships where we provide a candid, fresh and frank look into relationships with goals of acceptance, respect and flexibility. I’m Frank Love and you can find me, my blog and my various social media incarnations at franklove.com.
Once again, I’m joined by my co-host, Dr. Gayle. We’re going to find out what’s in her bag of tricks on the psychology side as we get up to speed on reproductive and urologic health. What’s up, Dr. Gayle?
Dr. Gayle: What’s up, what’s up, what’s up, Frank?
Frank: Men often define ourselves by our virility, sexual ability and even how much money we make. Well, today’s guest doesn’t usually help on the money side, but he’s quite knowledgeable when it comes to issues concerning the urologic systems and the reproductive system in men. We’re about to spend an hour discussing issues pertaining to the prostate, vasectomies and penis enlargements. So, join me as we talk with urologist, Dr. Chiledom Ahaghotu. Good morning.
Dr. Ahaghotu: Good morning, Frank. Glad to be here this morning.
Frank: Thank you. What does a urologist do?
Dr. Ahaghotu: Well, urologists are surgeons that specialize, as you just mentioned in the genital, urinary system, which is the kidneys and the urinary tract; basically, the human plumbing system. And then, we also specialize in male reproduction. So, sexual function, fertility and those sort of things.
Frank: Instead of a woman visiting a urologist, a woman would see who?
Dr. Ahaghotu: A gynecologist. However, women do see urologists for urinary concerns like, incontinence or leakage of urine, certain cancers, like kidney cancer, bladder cancer and that sort of thing. But in terms of female reproduction, that’s for the gynecologist.
Frank: I once talked to a urologist who told me, that 50 percent of men over a certain age have prostate cancer.
Dr. Ahaghotu: Yeah, yeah. It’s very, very common and I would agree with that estimate in men that are above the age of 80. About half of them will have some form of prostate cancer, either the dangerous form or the not-so-dangerous form.
Frank: Okay, so just because you have it, it doesn’t mean you’ll die from it.
Dr. Ahaghotu: That is very, very correct. In fact, studies have shown that or statistics have shown that most men who are diagnosed with prostate cancer, do not die of prostate cancer.
Dr. Gayle: What causes prostate cancer?
Dr. Ahaghotu: That’s a great question, Gayle. I mean, Dr. Gayle, sorry.
Dr. Gayle: No problem.
Dr. Ahaghotu: You know, that is a question that a lot of people are trying to figure out. That is why do people get prostate cancer and then of those who get it, why are some of those cancers very dangerous? And we don’t know. We do know that as you get older, you’re more likely to get it. It’s probably a combination of genetic factors and also the environment probably contributes as well.
Frank: Would you talk a bit about the different forms of prostate cancer?
Dr. Ahaghotu: Absolutely, what I usually tell my patients is that there are two kinds of prostate cancer. There’s the good kind and there’s the bad kind; if there could be a good kind of cancer. And the good form of prostate cancer is what we were just talking about and that is the very common cancers that arise in men as they get older, that under normal circumstance you wouldn’t even know you have it.
And many men will go on to live out their natural lives and end up having a small area of cancer in their prostate that was never detected. That was shown by a very large study, looking at autopsy specimen and finding that a lot of men who died of natural causes, when they looked at their prostate there was actually a little bit of cancer there. So that’s the good version of prostate cancer. That’s the kind that we really don’t even want to find.
It’s the other form, the bad form of prostate cancer that’s more lethal and that’s the form that tends to occur in relatively younger men. So, men under the age of 60, it tends to spread to organs outside of the prostate, like the bone and the liver and it tends to without proper treatment, it can actually be lethal.
Frank: Wow. Now, there’s actually a computer program or something of that nature, where you can put in certain information and find out what the life span is of the individual with a certain type of prostate cancer. Could you tell us about that?
Dr. Ahaghotu: You’re absolutely right, Frank. There is a website that you can go to on the National Cancer Institute–actually it’s the National Cancers, to website, that allows you to put in information about your cancer, if you’ve been diagnosed with prostate cancer, and gives you an estimate of whether or not that cancer is dangerous for you or not.
We call those, risk stratification tools. And the kind of information you’d be putting in would be your PSA, your biopsy information, your age, family history and that sort of thing and the software program stratifies you out and gives you a sort of general estimate of what your risk is.
Frank: What is PSA?
Dr. Ahaghotu: PSA is a protein that all men produce. In fact, everybody produces it, but men produce it in detectable levels. And it’s a protein that’s produced by the prostate and we can measure the amount of that protein in our blood and it’s supposed to be a certain value. And as that value starts to rise, it raises concerns about diseases in the prostate. And, of course, the most concerning disease, is prostate cancer. So, it actually stands for Prostate Specific Antigen, PSA.
Dr. Gayle: How early should men start getting tested for prostate cancer?
Dr. Ahaghotu: Dr. Gayle, that’s a real controversial question right now. There’s a lot of debate about whether or not we should recommend PSA testing. However, the organizations and there are several of them that recommend screening, recommend starting screening at the age of 40 and doing it annually until about the age of 70. And again, there is some debate as to who should be screened and at what age, but that’s sort of a general recommendation.
Dr. Gayle: What’s the debate?
Dr. Ahaghotu: Well, the debate has to do with whether or not PSA testing or prostate cancer screening–pretty much the same thing–actually saves lives. Whether or not by going to get screened, you’re at risk of identifying that good form of prostate cancer that otherwise wouldn’t be a problem for you. And so obviously, if you pick that one up and then you go down the pathway of getting all these treatments without any benefit, then you get all the side effects or potential side effects without any benefits. Whereas, obviously the only way to find the cancer, is to look for it and if you do, you might find that more dangerous or the bad form of prostate cancer, which we do want to find, because when you get that one, if you don’t get it treated, it could be a problem.
Frank: You said from between 40 and 70. Well, what is a man who is older than 70 do? Does he just resign himself to possibly dying from it and not being treated?
Dr. Ahaghotu: Well, we don’t want that to happen. So Frank, the reason why there are recommended limits to how long you should screen is that studies have shown that if you get to a certain age and you have not developed prostate cancer, chances are it is not going to be a lethal form of prostate cancer. So, it’s just one way of trying to filter out those individuals who are more likely to get the bad version.
Now that being said, that 70 cut off is not a hard cut off. If you are healthy, if you’re concerned about your prostate, or your genital urinary health, you certainly can have a conversation with your doctor and you very well may continue to need to have PSA testing; particularly if you are having any kind of urologic symptoms.
Dr. Gayle: How much does genetics play into it and how much does the environment play into it?
Dr. Ahaghotu: Well, we believe that both play an important role and like many things in life, prostate cancer is often unique to individuals. So, for one individual, genetics may play a more significant role and in another individual, environment may play a more significant role. But we do know that there are genes that increase your risk of developing prostate cancer. And we do know that there are environmental factors, particularly dietary factors that increase your risk of prostate cancer as well.
Dr. Gayle: What are those genes?
Dr. Ahaghotu: There are a few genes that we feel strongly about and that there are other genes that we’re exploring as well and essentially these are mutations that occur in the natural genome that increase your risk of prostate cancer, either in the general population or in certain ethnic groups. However, none of these have been mainstreamed as a test that you can do to determine whether or not your risk is really that high.
And the reason why is that they really have not figured out how to use these tests in the general day-to-day practice. So, most of the genetic studies that are being done are still being done in the experimental situation and not being done in regular practice.
Frank: What are some of the dietary issues that lead to prostate cancer?
Dr. Ahaghotu: Probably the most important is your fat intake. The so-called Western Diet, as it’s been described, is very rich in the saturated fatty acids. Those are the, basically, the red meat related fat and those saturated fatty acids apparently, in large quantities over a period of time, increase your risk of developing prostate cancer. Probably other cancers and it’s related to the by-products of your body breaking those fats down, releasing what we call, free oxygen in radicals which damage the cells and turn on cancer behavior.
We pretty much confirmed that diets that are rich in red meat tend to increase your risk of prostate cancer. And in reverse, the unsaturated fatty acids like the Omega fatty acids, like you find in Olive Oil and the so-called Mediterranean Diet, have an opposite affect. And that’s why you see that the incidents of prostate cancer are so low in Mediterranean and also in Asian countries.
Frank: I’m going to mention a few products or categories of products and I want you to tell me how it plays into how it has to do with the prostate, prostate Cancer. First up, alcohol?
Dr. Ahaghotu: Alcohol, there have been no direct links between alcohol intake and the development of prostate cancer. As you know, there have been other relationships between alcohol and other cancers. And in fact, as you know also, there have been studies that have shown that small to moderate amounts of alcohol actually maybe beneficial; certain types of alcohol. But alcohol abuse in general is very unhealthy, but there have been those links to alcohol intake and prostate cancer.
Dr. Ahaghotu: There have been some studies that have shown a relationship between cigarette smoking and risk of that bad form of prostate cancer or aggressive prostate cancer. So, we just submitted a study looking at African American men who smoked verses those who didn’t and found that of those African American men who smoked and had prostate cancer, they were more likely to die of prostate cancer than if they didn’t smoke.
We concluded that there’s a relationship between smoking and developing a more lethal form of prostate cancer. And that’s pretty much consistent with what has been published in the past. There is, what we believe, a relationship between smoking and the aggressive form of prostate cancer.
Dr. Ahaghotu: Zinc is an important element in our diet, that supports a number of cell functions and the primary relationship and urology between zinc and urologic function is more related to fertility.
There haven’t been any studies that have shown a relationship between Zinc deficiency and prostate cancer, but generally in men who were evaluating for fertility, Zinc supplementation is one of the things we recommend, because it helps to support the function of the sperm tail that’s important in fertility.
Frank: Saw Palmetto?
Dr. Ahaghotu: Saw Palmetto is a great product in my opinion. It seems to– and we’re not really sure of the mechanism–but it seems to improve male urinary symptoms. So those men who as they get older are noticing that they’re having to go more frequently, having that feeling of urgency and that sort of thing, Saw Palmetto seems to decrease those symptoms in a group of men.
However, the study that looked at Saw Palmetto in it’s relationship with prostate cancer, have not found any preventative benefit. So, it doesn’t seem to reduce the risk of prostate cancer, but it can be helpful in men who have urinary symptoms. So I often will use that in my practice as well.
Frank: Prostate supplements, like Beta Prostate or Prostate 19?
Dr. Ahaghotu: You’ve got to really be careful with some of these supplements, especially the ones that have a number of different active ingredients, *(inaudible) 16:23, Beta Prostate. I’m not saying necessarily that they’re bad. However, you certainly should bring those products in to your provider and go over the ingredients, because some of these products contain anabolic steroids, testosterone and testosterone substances, which can actually be dangerous, if you have prostate cancer, because they can actually make the prostate cancer more aggressive. So, you have to really be careful with some of those products out there.
Frank: Talk about these relationships between steroids and prostate cancer or prostate health.
Dr. Ahaghotu: Testosterone is a steroid. It’s an anabolic steroid and testosterone is the major of food supplied to the prostate. That is the prostate needs testosterone to maintain itself, to function properly. And so, one of the things that will happen in patients who have prostate cancer is we have to be mindful of testosterone, because testosterone can actually make that cancer grow and so, one of those strategies in treating prostate cancer sometimes is to lower the testosterone, to try to starve the cancer cells. So, there’s a very close relationship between testosterone and the prostate and so that’s the connection with steroids.
Dr. Gayle: How does all this–the prostate, prostate cancer difficulties with prostate–how does that affect relationships?
Dr. Ahaghotu: The prostate is one of our internal reproductive organs, so it’s considered a male reproductive organ. Its primary role is to produce some of the secretions that are expelled when the male has a climax. And so it’s very important from a fertility standpoint. It produces the secretions that bathe the sperm and give the sperm nutrition and put it in the right environment to make it viable. Also, the nerves that give the erection, that promote the erection, are sitting right on the side of the prostate. And so those connections are important for, not only male fertility, but also for male potency.
Dr. Gayle: So oftentimes there is a difficulty with the male, do you see in your practice that it causes separation or divorce in couples?
Dr. Ahaghotu: Yes, unfortunately, having male sexual dysfunction can take it’s toll on the relationship and the prostate not being healthy can be one of the causes of male sexual dysfunction.
Dr. Gayle: And is there a number or are African American men verses Caucasian men, who gets prostate cancer more often and who dies from it?
Dr. Ahaghotu: So glad you asked that question, because that’s been the main body of my work over the last 20 years in practice. African American men are at much higher risk of developing prostate cancer and dying of prostate cancer. African American men are 60 percent more likely to be diagnosed with prostate cancer in their lifetime and also three times more likely to die of prostate cancer. And that’s a very, very sobering statistic.
We also know that African American men, when they do get prostate cancer, are much more likely to get the more advanced form of prostate cancer; four times more likely to be diagnosed with the cancer and that has already spread at the time of diagnosis.
Frank: Well, they’re three times more likely than who?
Dr. Ahaghotu: Than our Caucasian counterparts, so that’s the comparison.
Dr. Gayle: And is that due to early detection? Is it due to environmental problems or factors? What’s that due to?
Dr. Ahaghotu: Probably all of the above and plus some.
Dr. Gayle: Okay.
Dr. Ahaghotu: We believe that there are probably some genetic factors that play a role for African American having more aggressive disease than Caucasian men. We also believe that there are environmental factors. It’s just not clear as to why this disparity is so substantial. In fact, over the last few years, we’ve actually seen a decline in the death rate due to prostate cancer; both in African American men as well as in white men. However, the decline is not as steep in African American men. So, there’s still a huge gap in the risk of death due to prostate cancer.
Frank: Are there cancers that Caucasian men might get more than African American men?
Dr. Ahaghotu: Urologic cancers? Yes.
Dr. Ahaghotu: For example, Caucasian men are more likely to get testicular cancer. It’s much more common in Caucasian men than it is in African American men.
Dr. Gayle: And what is testicular Cancer?
Dr. Ahaghotu: The testicles are the sort of the ball-like structures that sit in the scrotal sack that are responsible for producing sperm and also responsible for producing testosterone. So, they’re very, very important organs and they can become cancerous, especially in men in their 20’s and 30’s. So, it’s a disease of younger men. In fact, it’s only second to leukemia as the most common cancer diagnosed in men in their 20’s and 30’s.
Dr. Gayle: Wow.
Dr. Ahaghotu: It is pretty common and it seems to be–as Frank mentioned, it seems to be more common in Caucasian men.
Frank: You mentioned that the prostate dysfunction can take tolls on relationships. Are there any particular age ranges that you see this in? Let’s say a relationship is between two people who are 60. Do you see it there? Seventy or more so 40 and 30?
Dr. Ahaghotu: Frank, what we’re seeing is, we’re seeing a growing population that is experiencing, worsening erection problems or sexual dysfunction and prostate disease is just one of the many causes of sexual dysfunction. So, when men start into their 30’s and 40’s, the incidence of sexual dysfunction starts to rise. In fact, about 30% of the men in their third decade of life, in their 30’s will have some degree of sexual dysfunction. That’s a pretty high number if you consider–
Dr. Ahaghotu: A 30 year old. I remember when I was 30, and in that number–
Dr. Gayle: That is a high number.
Dr. Ahaghotu: It is and the number goes up about 10 percent per decade. So, men in their 40’s have a 40 percent risk of having erection problems, 50 percent in their 50’s. And it just keeps going on up like that, so that when you get into your 70’s and 80’s, it’s almost a 70 to 80 percent chance of having some degree of sexual dysfunction. And as I mentioned, prostate cancer is just one of the causes of sexual dysfunction.
Dr. Gayle: Now are those newer numbers or have the numbers decreased or increased over the years?
Dr. Ahaghotu: Well, these are newer numbers and part of it is, again, because of better health care access in general, of course.
Dr. Gayle: Right.
Dr. Ahaghotu: And also, we’re in the information age and so we–
Dr. Gayle: Right.
Dr. Ahaghotu: Have better ways of gathering data. But that’s sort of the current estimate of risk of having sexual dysfunction.
Frank: What are some of the other sexual dysfunctions as it pertains to men, besides those related to the prostate?
Dr. Ahaghotu: The number one cause of sexual dysfunction is related to diabetes and hypertension. Uncontrolled hypertension and sometimes some of the medicines that you take for hypertension can affect your sexual function and often do.
Another important cause that we don’t talk about often, is smoking. Smoking blocks the arteries that supply the penis, just like they block the arteries that supply the heart and so there’s a direct and quantitative relationship between smoking and sexual dysfunction as well.
So, if you put those three together, smoking, high blood pressure and diabetes, you can see why the incidence of sexual dysfunction is actually, pretty common.
Frank: You’re listening to Frank Relationships and we’re talking with urologist, Dr. Chiledom Ahaghotu, about prostate cancer, prostate issues and other urologic and peproductive issues. Please tell our listeners how they can reach you.
Dr. Ahaghotu: I’m located at Howard University Hospital in Washington, D. C. Our number here is 202-865-7721, or you can contact the Howard University Cancer Center. We offer free prostate cancer screening monthly and our number is 202-806-7697.
Frank: You mentioned the information age and I am one of those people that believe that there’s an up and downside to pretty much everything. What’s the downside to there being such a accessibility to information pertaining to the prostate and the urologic system and all of that good stuff?
Dr. Ahaghotu: I agree with you Frank. That’s a great question. I haven’t really thought that much about it, but it’s obviously very, very important. I think there is a downside, like you said to everything and if we talk about information overload, I would say that that’s the downside in that, if you take the information that you’re getting on the internet or what you read and you don’t sit down and talk with an expert in the area, you could come to certain conclusions or make certain decisions that actually could be harmful.
I think the information age is wonderful and I think that it’s an opportunity for us to live healthier lives, but I do think that we also need to work with health care providers in making these decisions.
Frank: Penis enlargements in terms of the actual procedure and pills, please I’ve heard them on different radio shows. Actually, I’ve seen commercials, please weigh in. Tell me, are they good things, bad things.? Are they complicated? Are there heavy complications?
Dr. Ahaghotu: Let’s talk a little bit about that. That is, penis enlargement and there have been two–that I’m familiar with–two approaches to penis enlargement. One is, as you mentioned, medical therapy and a lot of that just has to do with trying to increase blood flow. So those kind of drugs like Viagra and Cialis, those kind of things taken at low doses on a regular basis, have been used to try to increase penile engorgement. And there have been no studies that have shown that they’re effective.
Dr. Gayle: Oh, wow.
Dr. Ahaghotu: So, when I look at the ads that are out there promoting these kinds of products, again, I just feel sorry for folks who are just using their hard earned money and not really getting any input from experts about whether they’re effective, because they have not been proven to be effective.
Frank: Viagra is not proven effective?
Dr. Ahaghotu: For penile enlargement. It certainly is effective in causing a erection–
Frank: Got you.
Dr. Ahaghotu: Which allows you to have successful intercourse. However, in terms of something that is going to cause some kind of enlargement of the penis, it’s certainly not Viagra and there’s no product out there, I know that will do that.
There are surgeries that have been done in the past, to try to enlarge the penis. These surgeries have, in general, not been successful.
It was real popularized on the west coast and there were actually some urologists that lost their board certification due to very, very bad outcomes and what we believed was outside of the standard of practice.
These surgeries, just to tell you very, very briefly, involved using fat that you take from one part of the body and try to inject it into the skin around the penis to make it larger. They’ve done procedures where you release certain ligaments to try to give the penis the appearance that it’s larger. None of these–
Frank: Are these ligaments in the penis?
Dr. Ahaghotu: Well, they’re ligaments that are attached to the penis to keep it suspended in a certain position and by taking them down and it repositions it and gives it the appearance that the penis is larger. However, again, those procedures have not had good outcomes in general.
And most urologists, certainly well trained urologists do not perform penile enhancement surgeries. So, it really is not a well accepted strategy in terms of trying to enlarge the penis.
Dr. Ahaghotu: Yeah, I know. Maybe something is going to come out in the future, but as of now, there really is nothing out there that I would recommend to any patient.
Dr. Gayle: Wow, so nothing works, huh?
Dr. Ahaghotu: Well, now the flipside is, there are treatments that will allow a man to be able to have a healthy sexual life with the gifts that he’s been given to him, but in terms of giving him something that he was–
Dr. Gayle: That was a great way to put it.
Dr. Ahaghotu: Yeah, giving him something he hasn’t been given, that just hasn’t been identified yet.
Frank: Back to relationships. Penis size, wanting to increase penis size, how have you seen that affect relationships?
Dr. Ahaghotu: Yeah, I see it in my practice all the time and one of the things that we do see in men as they get older is, particularly if they are not maintaining their body habitus is that they can sometimes start having a lot of fat distribution down around in that area and it can give the penis the appearance that it’s actually getting smaller. And that is a concern that I get from a lot of men when they come in as they get older. And obviously one of the remedies to that is stay in shape.
Dr. Gayle: Lose weight.
Dr. Ahaghotu: Go to the gym, do those push-ups, keep the weight down, try to maintain. And so that’s one thing. But it certainly can, either do to perception or reality, have it’s toll on the relationship.
Frank: Do you get the reports of these kind of issues from the female? Does the partner ever come to her husband or her partner’s doctor’s appointment and go off? Is she upset? Does she want to know what the heck is going on? How come he, this that and the other?
Dr. Ahaghotu: I rarely see that, Frank. I mean maybe once or twice over my entire career, have I seen a female partner come in and really sort of take the lead in complaining about what’s going on behind closed doors.
A lot of times a more typical scenario is that the male will come in by himself and speak on behalf of his partner and say that his partner has complained and that sort of thing. And then, when I sort of try to get more information, sometimes it comes out that really the partner hasn’t complaint and it’s his perception of what the partner wants or expects. And whether or not that perception is real or not is sometimes difficult to sift out. But I approach it from the standpoint that if the male is having concerns, whether it’s perceived concerns or real, I’m going to still address it and then go from there.
Frank: Vasectomies, they are often suggested by women as a way to stop future pregnancies and all of that–
Dr. Gayle: Why’d you roll your eyes at me?
Dr. Ahaghotu: I wish I was in the studio to see your face.
Frank: I’m getting to that age where that conversation comes up and I–
Dr. Gayle: Listen, women have been taking the lead for that for years, birth control and all these crazy things. It’s time for you guys to step up.
Frank: Alright, Dr. Ahaghotu, what do you have to say about that?
Dr. Ahaghotu: Frank, I’m going to agree with Dr. Gayle on this one.
Dr. Gayle: Thank you, finally. Geez.
Dr. Ahaghotu: The vasectomy is a very simple and effective anti-fertility procedure. It’s typically done in the office. It involves tying off those two tubes that bring the sperm from the testicle to the penis. And there’s a lot of sort of urban legend around vasectomies. It’d be nice to talk about a little bit about that. One is, does vasectomy affect your potency. And the answer is absolutely not.
Dr. Gayle: What do you mean by potency?
Dr. Ahaghotu: Your ability to have erections, your virility, your sex drive–
Dr. Gayle: Okay.
Dr. Ahaghotu: Your performance. And it has no impact on any of that. All it does is, it just blocks the flow of sperm from the testicle to the outside and it’s a very sort of, very simple mechanical– it’s a lot easier to do than many of the female reproductive type of things like, tubal ligation or intrauterine contraceptives and all of those things that, for women, really can have significant side affects.
Dr. Gayle: Right.
Dr. Ahaghotu: But the vasectomy is straight forward. The only thing about the vasectomy is, it’s pretty much irreversible. So, if you get it done, you’ve got to understand that you burnt a major bridge there.
Dr. Gayle: What? You trying to have more kids? You already got four. What’s going on, Frank?
Frank: What can I say? I love my babies.
Dr. Gayle: Geez.
Dr. Ahaghotu: The other thing I have to mention is that vasectomy does not prevent any sexually transmitted diseases.
Dr. Gayle: Right.
Dr. Ahaghotu: And I always tell my men that. Yeah, you can get this done, if you’re going to be out there and you are in a risky environment, you still have to practice safe sex.
Frank: Let’s talk about STDs. What is the most pervasive STD that you see?
Dr. Ahaghotu: Well, in the D.C. area, we see quite a bit of genital warts, which is caused by a virus; the Human Papillomavirus virus. Men can get it, women can get it. And in women, it’s actually associated with cervical cancer. So, it’s something that we take pretty seriously. We still see quite a bit of the Gonorrhea and Chlamydia and then, of course, HIV and Hepatitis C are also sexually transmitted and so we see quite a bit of that as well. There’s also a recent increase in the incidence of Syphilis, which we thought had pretty much–
Dr. Gayle: That’s like an old school STD, right?
Dr. Ahaghotu: Yeah, we thought that we had control of Syphilis, but we’re seeing a rise in Syphilis in certain populations. So, there’s still quite a number of sexually transmitted problems out there.
Frank: Have you seen a relationship between the–what is it–the bacteria that is becoming resistant to antibiotics and the current Syphilis or any of these germs?
Dr. Ahaghotu: I’m glad you brought that up. No, we haven’t seen a connection between the antibacterial, say, organism that is emerging. That’s a really scary thought, that there is a bug or a group of bugs out there that is becoming resistant to all the available antibiotics that are available in the world right now.
And so, some people believe that we’re really moving towards what they call, a post-antibiotic era. Where antibiotics will become obsolete and if we don’t discover some new way of treating these infections, that it could lead to some kind of major epidemic or even pandemic. So that is definitely worrisome.
Frank: Absolutely is. When I think about it, I think of War of the Worlds and–
Dr. Ahaghotu: Yeah.
Frank: How the bad guys were ultimately defeated by bacteria or was it a virus or something like that and how that could potentially affect us?
Dr. Ahaghotu: Uh-huh.
Frank: Infertility, how do you help with infertility?
Dr. Ahaghotu: For urologists, we kind of deal with the male side of infertility and as we talked about earlier, the gynecologist deals with the female side of infertility. Infertility is a two-way street. Back in the old days it was this, again, myth that when a couple had infertility, it’s primarily due to the female. Well, we now know that is just not the case.
In fact, half of the time, there’s a male factor involved in an infertility scenario. About 50 percent of the time and–
Dr. Gayle: What are the common male factors?
Dr. Ahaghotu: Some of the male factors include prior history of sexually transmitted infections, which can damage the tubing. Men that have had a hernia surgery, sometimes the tubes can be damaged as well.
Sometimes it’s just genetic and you just have low sperm count. So there are a number of factors that contribute to male infertility and so because of that, as well as because it’s so easy to evaluate, the first step when a couple comes in is to check the male out. And we do that by simple, what we call semen analysis study, to assess how many sperm are there and whether the sperm are healthy.
Frank: Do you start with the male, because it’s cheaper and easier?
Dr. Ahaghotu: Absolutely, it’s a lot easier to do. It’s cheaper to do and we now know that about half the time the male contributes in some way to the infertility issue.
Frank: We’ve been talking significantly about the male side of it. What are some of the female urologic issues?
Dr. Ahaghotu: We don’t deal a lot with the female reproductive system, but the female also has a urinary tract, so the kidneys, the ureter, which is a tube that drains the kidneys, the bladder; all that is part of the urinary system and so, when you have problems in those areas, the urologist usually takes the lead. So, conditions like kidney stones, incontinence, which is inability to hold the urine.
As women get older, sometimes the support mechanisms that allow them to stay dry, kind of start to fail and when that happens, you can develop what we call incontinence. So, urologists often manage incontinence. If you have a certain cancer, like bladder cancer, unfortunately women can also get bladder cancer, kidney cancer; all of those things are within what the urologist deals with.
Frank: I wrote a piece a while ago, called, Unprotected Sex Feels Better, and just a few minutes ago, we were discussing STDs. How do you merge the issues around both?
People clearly, people having children, people who are having children that they did not expect or want to have, people are having abortions, clearly people are having unprotected sex. However, on the other side, there are plenty of STDs and most people know it. When you sit down and talk to a man or a woman about these two issues, what do you tell them?
Dr. Ahaghotu: Well Frank, it’s some times a hard conversation, but if I was going to sort of sum it up in two words, I would say, “Responsible sex.” Certainly if the preference is unprotected intimacy, then there should be certain rules. One is, know your partner. Random encounters is risky and you just never know what’s going to happen in that situation. One, know who you’re dealing with. Two, if there are concerns, testing. I know it doesn’t sound romantic, but go to the doctor and get checked out and make sure you both are okay.
These are the things that obviously if you have the benefit of having a monogamous relationship and then that’s your preference, that is also–just by statistics, it reduces the number of encounters. So, these are some of the things you have to take into account, but I think it starts with really being responsible and realizing the ramifications of risky behavior.
Frank: Got it. You’re listening to Frank Relationships and we’re talking with urologist, Dr. Chiledom Ahaghotu, about prostate and other urologic issues. Please, once again, tell our listeners how they can reach you.
Dr. Ahaghotu: You can reach us at Howard University Hospital 202-865-7720.
Frank: Do you ever find yourself, working closely with a gynecologist, sitting in the same room or working on a project together, and if so, what’s that look like?
Dr. Ahaghotu: All the time. I have great gynecological partners here at Howard University Hospital. We have a really good department of obstetrics and gynecology. We train OBGYN residents, and usually the kind of things we partner on, are as you would imagine, female related concerns.
Often, women who are having problems with incontinence, may also be having problems with their sexual function and we will often come together. For example, if a female has decided that she wants to have a hysterectomy or if it’s important in terms of her health, often that procedure is done and then a subsequent procedure may need to be done by the urologist. So we often work together on those kind of issues. Sometimes, unfortunately, there are complications from gynecological surgery that require urology involvement. So, we work very closely with our gynecological colleagues.
Dr. Gayle: And I was also wondering, is prostate cancer in men, what breast cancer is in women?
Dr. Ahaghotu: Yes, I would say there’s some definitely some correlates. Breast cancer as you know is very prevalent in women in the United States and prostate cancer is very prevalent in men in the United States. African American women have a higher death rates from breast cancer, just like African American men have higher death rates from prostate cancer than Caucasians.
There are genetic factors that are associated with breast cancer and there are genetic factors associated with prostate cancer. So, I think that there are definitely a lot of similarities. Breast cancer though, I think the awareness level is higher. I think women have really been activated in the public and have driven the research on breast cancer. As you know with the foundations like Susan G. Komen and those kind of foundations that have really been active.
I think we can learn a lot from what’s happened in breast cancer. So, yeah, I think there’s some relationships.
Frank: There’s an issue I got to talk to you about, Dr. Ahaghotu:.
Dr. Ahaghotu: Sure.
Frank: It’s major. I don’t like it. It’s no fun. You know where I’m going.
Dr. Ahaghotu: I don’t know.
Frank: There are jokes that have been made about it on television, all over the place. My man on the boards over here smiling. I don’t like it.
Dr. Gayle: Just say it. Just say it.
Frank: The dreaded finger in the butt.
Dr. Ahaghotu: Oh, okay.
Frank: Dr. Ahaghotu, what are you guys doing back there?
Dr. Ahaghotu: That’s a good one, Frank. You’re talking about the infamous finger wave test, urologists–
Dr. Gayle: He even turned his back to me. You should see.
Dr. Ahaghotu: Oh my gracious.
Frank: I had to get comfortable. I had to lean back on my chair. Just bringing it up is a problem.
Dr. Ahaghotu: In the urology circles, we call it the urologist handshake.
Frank: That’s not funny.
Dr. Gayle: Whatever you need to say, right, to make yourself okay.
Dr. Ahaghotu: You’re talked about the Digital Rectal Examination or DRE. That’s how it’s been coined and it is one of the two components of prostate cancer screening. Prostate cancer screening involves the PSA test, which we talked about earlier, followed by a Digital Rectal Exam. And I’ll be honest to you, if I explain it, hopefully, that’ll help to dispel some of the fear and the myth around it. So, essentially what the doctor is doing is using a gloved finger and placing it into the rectum to feel the prostate. And the prostate sits on the wall of the rectum, so you really get a sense of how healthy that prostate is.
The examination literally takes about ten seconds and after getting over the fear and the anxiety of being in that situation, most men will tell me that they’re glad that they had it done, because it helped to alleviate any of the anxiety that something’s going on and they felt better about the fact that they’re doing something proactive about their health.
When I explain it to them in that way and we sit down and talk about it, it’s usually not a major barrier. The barrier is when they don’t have the conversation. You talked about information out there. You go on the internet, you see the pictures and all that and then you just make a decision as opposed to going in and talking to somebody who can explain what’s going on and hopefully help you to get it done.
Frank: You guys are not just screening. I have heard and have felt there’s also a massage you guys do at times.
Dr. Ahaghotu: You went there, huh?
Frank: What’s that about?
Dr. Ahaghotu: So, yeah, you’re right, Frank. For a very small select group of men who have a condition we call Prostatitis, which is when the prostate is swollen or inflamed, we can sometimes actually, in addition to just feeling the prostate, we can actually press on it and sort of decompress some of the material that gets sort of caught up in the prostate over many years. And so that can provide relief in men who are having a lot of pain and discomfort related to that condition of prostate cancer. But that is not what we routinely do when we do a DRE. That is a rare–not rare, it’s an uncommon type of thing that we do for a specific condition.
Dr. Gayle: So you guys just go up in there and check to see if it’s enlarged or–
Dr. Ahaghotu: Exactly. So under normal circumstances, all we’re doing is just going in there, just kind of softly and gently feeling the prostate for a few seconds and then that’s it.
Frank: What is Chronic Prostatitis?
Dr. Ahaghotu: Chronic Prostatitis is a condition where the prostate gets swollen and very tender. Most men will experience pain in that area behind the scrotum. They also sometimes have back pain or groin pain. Some men with Prostatitis will say that they’re having erection problems and that would be a big concern. Sometimes they talk about having fatigue or just not having good sex drive. All of these can fall within the spectrum of a condition we call Chronic Prostatitis.
Frank: The kidneys, what can you say about good kidney health as it pertains to basically the male reproductive and urologic system?
Dr. Ahaghotu: The kidneys are really important, Frank. They’re the filters of the body. So all of your blood circulates through the kidneys in about two minutes. Every minute about all the blood in your body goes through the kidneys and it filters all that blood and then takes out the poisons and the toxins and then that makes urine and then the excess water and that’s what makes urine.
It’s a very, very important organ. Staying hydrated is really important. As you can imagine, since it filters the blood, anything that you do that’s unhealthy can affect your kidneys; diabetes, hypertension. All the things we talked about: smoking, bad diet. All of those things can potentially damage your kidneys, and so, what I generally say when people ask about kidney health is really just think about overall health. So if your whole body is healthy, then your kidneys are going to be healthy.
Frank: Do you find that men who drink a lot of water don’t have those types of issues? And do you recommend drinking a lot of water?
Dr. Ahaghotu: Excessive water is actually problematic. I don’t know how we got into this sort of age of all of this excessive water drinking. What I generally say is three 12 ounce glasses of water a day. That’s 36 ounces. That’s more than enough water for most people, unless you’re running marathons every week.
If you’re doing things that are causing you to lose excessive amounts of water, then obviously you should increase your water intake. But for the average person, 36 ounces is more than enough water and if you drink excessive amounts of water, then it’s going to do a number of things.
One, you’re going to go to the bathroom a lot and that can be a problem for some folks, especially as they get older. And then the other thing that can happen, if you really drink excessive amounts of water, you can actually dilute out your kidneys. So your kidneys don’t work well if you have excessive amount of water intake, because all of that excess water has to flush through the kidneys and it can cause the kidneys not to function well.
Frank: I tell you, we are uncovering all kinds of good stuff today. You discussed the prostate, the massage. Does the prostate look different or have a different state in gay men, because there’s activity–
Dr. Gayle: Because theirs is massaged so frequently.
Dr. Ahaghotu: I don’t think so. I haven’t come across any studies that have looked specifically at the anatomy in gay men verses men who are not gay. However, and the other thing is that the massage, the prostate massage that we do as urologists is very technical. So you’re actually identifying the prostate and you’re pressing on it.
Dr. Gayle: It’s not sexual?
Dr. Ahaghotu: I think that’s a very different, that’s a very different specific type of thing, maneuver that we’re doing in urology and I don’t think it correlates to anything else that I’m aware of. As a urologist I don’t believe that there are going to be a lot of differences there; at least not related to that particular issue.
Frank: So when a doctor is performing it, what’s the difference between the massage and just the screening? And I’m sitting here in the studio, like my hands are moving, trying to figure out exactly–
Dr. Gayle: He’s so embarrassed right now.
Frank: Yeah, what’s going on? Was I being massaged or was I just being screened?
Dr. Ahaghotu: Hopefully, your urologist told you what he was doing, but–
Dr. Gayle: He don’t want to talk to him. He just–
Dr. Ahaghotu: You might want to come back and have a conversation with him about that. But, like I said, the prostate massage is a very specific procedure and we do it for very, very specific reasons. And in fact, there’s a school of thought in urology that it really doesn’t have any kind of benefit, but what some people feel is that it does help in decompressing the prostate. And so, to answer your question, Frank, when you’re doing the routine screening for prostate cancer, all you’re doing is you’re putting your finger in there into the rectum and you’re just lightly feeling on the prostate, whereas, when you’re doing the prostate massage you’re actually actively pushing on that prostate to try to shrink it, to try to get some of the material to come out and decompress the prostate. I guess that’s the only way I could describe it without diagrams or what have you.
Dr. Gayle: And starting at 40 the screening is what men get. Right?
Dr. Ahaghotu: That’s correct.
Dr. Gayle: So every year, you get this, starting at–
Dr. Ahaghotu: The prostate screening.
Dr. Gayle: The screen.
Dr. Ahaghotu: That’s right. And the DRE or rectal check or rectal Exam is part of that. And we do that once a year, starting at 40 to about the age of 70.
Frank: See, I could have very well been a victim of the information age, thinking I knew what the heck I was talking about and here we go. I thought the doc was massaging my prostate and he was just testing me.
Dr. Gayle: You felt a little uncomfortable?
Frank: But it was uncomfortable to say the least.
Dr. Gayle: That’s a question. That’s a question. How can you make heterosexual straight men feel comfortable with getting this procedure done? Is there a way?
Dr. Ahaghotu: Well, the first thing, Dr. Gayle, is to have the conversation, to really have that relationship so that you really know, because so much of what we do in medicine is based on trust and if you don’t build that trust or if you don’t really take that trust seriously, then it creates all kinds of feelings and emotions that can make the experience a lot worse than it actually is. So that’s one thing. Two, Frank to what you were talking about, different folks do the rectal exam different ways and I personally like to not do a lot of pressing on the prostate when we do the examination. I like to–
Frank: Thanks a lot.
Dr. Ahaghotu: Feel the prostate gently, especially sense the PSA information is so valuable and it gives us so much information. I don’t think that there’s usually a need to do a lot of pressing on the prostate.
Now, obviously if you feel something that you’re worried about, then you may spend a little more time in that area, kind of feeling on that. But generally it’s just kind of, you put it in there, you sweep and then you take it out.
Frank: Got it. You’re listening to Frank Relationships and we’ve been talking with urologist, Dr. Chiledom Ahaghotu, about the prostate and other urologic and reproductive issues. Once again, please tell our audience how they can reach you.
Dr. Ahaghotu: You can reach us at Howard University Hospital at 202-865-7721 or Howard University Cancer Center at 202-806-7697.
Frank: Along today’s journey we’ve discussed prostate cancer, vasectomies and penis enlargements. I hope you’ve had as much fun as I’ve had talking with Dr. Chiledom Ahaghotu about the urologic and reproductive systems.
As always, it’s my wish for you to walk away from this conversation with a heaping helping of useful information that will help you create a relationship that’s as loving and accepting as possible. Let us know what you thought of today’s show at facebook/relationshipflove, on twitter at @mrfranklove or at franklove.com. Until next time, keep rising, This is Frank Love.