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Choosing a BPH Treatment

You’re getting older. You wake up needing to use the bathroom every few hours. And even after you pee, you feel like you still have to. You might need to strain to get any kind of flow going.

You can’t get a good night’s sleep. Your friends ask you to join them on a day-long hike in the mountains, but you decline because you’re not sure there will be bathrooms nearby. Your partner expresses some concerns about your overall health. You wonder what’s going on?

Prostate growth can squeeze the urethra and disrupt urine flow

To many men, especially over the age of 50, this scenario has a familiar ring. These are all signs of a common, treatable condition: Benign prostatic hyperplasia (BPH) otherwise known as an enlarged prostate. Most of the time, the prostate gets bigger as men age. About half of men between the ages of 51 and 60 have some degree of BPH, according to the American Urological Association (AUA). The rates increase as men get older.

For some men, BPH is no problem. For others, prostate growth squeezes the urethra and disrupts urine flow.

Fortunately, there are lots of ways to treat an enlarged prostate.

Choosing a BPH treatment can be a challenge. It’s normal to have lots of questions:

  • Should I wait and see what happens?
  • Should I try medication?
  • Should I go with a minimally-invasive procedure? (And what does “minimally-invasive” really mean, anyway?)
  • Should I have surgery?
  • What are the risks of each treatment?
  • What will my recovery be like?
  • How long do the results last?

Treatment terminology can be confusing, too, with acronyms like TURP, TUIP, TULIP, HoLEP, HoLAP, TUMT and more. How can you determine which treatment options are right for you?

Your urologist can be both a trusted resource and a faithful advocate. Rely on your doctor’s training and experience as you weigh the pros and cons of your options. Don’t hesitate to ask questions.

Let’s look at some considerations doctors make when guiding BPH treatment decisions:

How severe are your symptoms?

Not all men have bothersome symptoms. Or their symptoms might happen just every once in a while. These men might decide on watchful waiting, holding off on any treatment and seeing if the symptoms worsen.

On the other hand, men whose symptoms affect their day-to-day life will probably choose a more active treatment path.

How large is your prostate?

On average, the prostate gland is about the size of a walnut and weighs about an ounce. Prostate growth varies from man to man.

If your prostate is growing modestly, your symptoms might not be severe. Typically, the larger your prostate, the more troublesome your symptoms will be. Some treatments are often recommended specifically for men with larger prostates. Your urologist will be able to discuss the treatment that is best suited for your particular condition.

How’s your overall health?

Are you generally healthy and fit, or do you have other medical conditions, like diabetes or heart disease, that complicate things?

For example, the AUA cautions about alpha blocker medications for men who need cataract surgery. This can be discussed and coordinated with your urologist and ophthalmologist. There are other minimally invasive treatments that can be used for men who can’t have surgery due to their overall health. Convective water vapor ablation (destroying excess prostate tissue with steam) might be a better option for men who don’t have success with BPH medications. Again, this and other treatment options should be discussed with your urologist to fit your particular needs.

Your treatment path may also depend on other urological issues you might be having, like bladder stones, bleeding from the prostate, blood in your urine, or difficulty emptying your bladder.

What’s your preference?

Some men are uncomfortable taking medications, or they might decide the side effects aren’t worth it. Others aren’t comfortable with having anesthesia or surgery. Still others might be reluctant to have procedures involving lasers, electric currents, or microwaves.

Other considerations: What are potential complications? What are the side effects? Will you have trouble with erections or ejaculation? Will there be significant pain? Does the treatment require a hospital stay? Will you have restrictions?

In some cases, your treatment decisions might be quite limited. In other situations, you might have a number of options to consider. You, your doctor, and your partner and family, if appropriate, can work together to come up with a BPH management plan that meets your needs.

Resources

UrologyHealth.org

“What is Benign Prostatic Hyperplasia (BPH)?”
(Updated: May 2019)
https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)

UpToDate.com

Cunningham, Glenn R., MD and Dov Kadmon, MD
“Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics)
(Last updated: July 24, 2018 with literature review current through June 2020)
www.uptodate.com (by subscription)

No doubt you’ve been trying to stay healthy in the midst of the coronavirus (COVID-19) pandemic. While it can be a confusing, unsettling time, scientists are learning more about the virus every day.

You might be wondering how COVID-19 may affect your sex life. Let’s take a look at some common questions.

Can COVID be spread through sex?

Yes. Scientists have found COVID in bodily fluids, including blood, feces, saliva, urine, gastrointestinal fluids, and semen.

You might not think of COVID-19 as a sexually-transmitted infection, but consider these points:

  • COVID can be spread through respiratory droplets, so coughing, sneezing, talking – and heavy breathing during sex – can be risky.
  • COVID is in saliva, so any kind of kissing puts you and your partner at risk.
  • COVID can linger on surfaces, so touching clothes, bed sheets, sex toys, and your partner’s skin could spread the infection.
  • COVID is in semen, so ejaculation raises risk for both you and your partner.
  • COVID is found in fecal matter, which you can come in contact with during anal intercourse or oral sex.
  • COVID is in blood and urine, too. So if there is any bleeding or urine leakage during sexual activity, the virus can be passed. “Period sex” while one partner is menstruating can be problematic.

Remember, too, that people can have the coronavirus and not even feel sick. We call this condition asymptomatic. People who are asymptomatic don’t have the usual COVID symptoms. In other words, you – or your partner - can have COVID and not even know it.

These are indeed unsettling times. There’s still a lot we don’t know. This virus is unpredictable, information about it is conflicting, and experts are racing to find the answers we need.

But there is still good news. There are ways to reduce your risk. And you can still have great sex in the age of COVID-19.

How can I reduce my risk?

It’s always important to practice safe sex, and it’s especially important now.

Keep these tips in mind:

  • Use a condom or dental dam every time. That means every time. With every sex act. Not just every sexual encounter. So if you and your partner have vaginal sex and oral sex in the same night, you need fresh protection for each event.
    What’s a dental dam? It’s a small layer of latex or polyurethane that serves as a barrier for oral sex. You place it over your partner’s genitals or anus to protect both of you from infections. You can find dental dams online or in drugstores. It’s also easy to make one: Snip the top and bottom off a condom with scissors and cut the condom lengthwise.
  • Limit your number of sexual partners. Having multiple sex partners has always been riskier than monogamy. Now that’s truer than ever. It’s fine to kiss and share intimacy with a committed partner you live with (as long as neither of you are sick), but casual sex and hookups have rarely been riskier.
  • Wash up! Wash your hands in soapy water before and after sex. You’ve probably heard the advice to hum “Happy Birthday” twice while you’re scrubbing. But you can pick a 20-second snippet from another song if it helps you remember.
    Don’t forget sex toys! If these “friends” join you and your partner in the bedroom, they should be thoroughly washed, too.
  • Know your partner’s status. We know this isn’t the sexiest conversation in the world, especially when you’re in the moment. But it’s critical to know whether your partner has a history of sexually transmitted infections. You should also know if they have been exposed to COVID-19 – or if they think they have. And you should be ready to disclose the same information to your partner.
    If you or your partner have any COVID symptoms -- like coughing, shortness of breath, or fever -- hold off on sex until you’re feeling 100% better. You might also consider getting tested for COVID.

Having great sex

So with all these restrictions, how can you still have great sex? Time to get creative.

  • Virtual sex. You and your partner can still share intimacy without physically being together. It might feel a little clumsy at first, but try to relax and give it a chance. Experiment by using a video-calling app such as FaceTime, exchanging videos or photos, or sharing audio-only calls. Set the scene with some soft music or candlelight. Tell each other what you’d like to do. Open up about your fantasies. And who knows? After the pandemic is over, you and your partner might have a new list of adventures to try in person!
  • Masturbation. Solo sex can be exciting, liberating, and fun. If you don’t have a partner or can’t be with your partner, relax and let your imagination take over. What would you be doing if you were together? What scenario have you always wanted to try? Sex under the stars? On a plane? The sky’s the limit when you’re fantasizing. Making these connections in your brain can trigger deeply pleasurable physical and emotional satisfaction.

Resources

Andrology

Perry, Melissa J., et al.
“It is currently unknown whether SARS‐CoV‐2 is viable in semen or whether COVID‐19 damages spermatozoa”
(First published: May 29, 2020)
https://onlinelibrary.wiley.com/doi/10.1111/andr.12831

Centers for Disease Control and Prevention

“Dental Dam Use”
(Page last reviewed: August 12, 2016)
https://www.cdc.gov/condomeffectiveness/Dental-dam-use.html

“What you should know about COVID-19 to protect yourself and others”
(Fact sheet. June 1, 2020)
https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf

International Society for Sexual Medicine

“Is it safe to have sex during the coronavirus (COVID-19) pandemic?”
https://www.issm.info/sexual-health-qa/is-it-safe-to-have-sex-during-the-coronavirus-covid-19-pandemic/

JAMA Network Open

Li, Diangeng, PhD, et al.
“Clinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease 2019”
(Research Letter. May 7, 2020)
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765654

Medscape Medical News

McCall, Becky
“SARS-CoV-2 in Semen of COVID-19 Patients?”
(May 7, 2020)
https://www.medscape.com/viewarticle/930127

SexHealthMatters.org

“Sex and COVID-19”
https://www.sexhealthmatters.org/did-you-know/sex-and-covid-19

NYC Health
“Safer Sex and COVID-19”
(June 8, 2020)
https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf

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