SAS 23

• The health history includes common or concerning symptoms such as sexual preference and sexual response.
• Approximately 1 in 10 patients may have same-sex, bisexual, or transgender partner preferences.
• These patients often experience significant anxiety during clinical encounters, related to fears of clinician acceptance, coexisting mental health conditions, sparse information about complex issues of hormonal therapy, surgical alterations, or transitions in gender identity.
• Lack of libido may arise from psychogenic causes such as depression, endocrine dysfunction, or side effects of medications.
• Erectile dysfunction may be from psychogenic causes, especially if early morning erection is preserved; also from decreased testosterone, decreased blood flow in the hypogastric arterial system, or impaired neural innervation.
• Premature ejaculation is common, especially in young men.
• Reduced or absent ejaculation affecting middle-aged or older men is less common and may be due to medications, surgery, neurologic deficits, or lack of androgen.
• Lack of orgasm with ejaculation is usually psychogenic.
• Men may be reluctant to report symptoms of sexually transmitted infections but should be encouraged to seek evaluation and treatment early.
• The best time to have a prostate-specific-antigen (PSA) testing and digital rectal examination (DRE) for an African-American male with a positive family history of prostate cancer is at 50 years and above.
• Processed foods, saturated fat, high sugar intake, and excessive intake of salt can increase the risk of the development of prostate cancer in men.
• Cryptorchidism is a condition where the testicular length is usually less than or equal to 3.5 cm.
• Epispadias in a male is a congenital displacement of the urethral meatus to the inferior surface of the penis.
• Signs and symptoms of prostate disorders include incomplete emptying of the bladder, urinary frequency or urgency, intermittent stream or straining to initiate flow.
• Pain felt in the inguinal canal due to inguinal hernia is usually aggravated by lifting heavy objects.
• Vesicles that are 1-3 mm in size found on the glans or shaft of the penis are usually indicative of genital herpes.
• A small red papule that becomes a chancre or painless erosion on a patient’s penis is a sign of syphilis.
• Penile discharge may accompany gonococcal (usually yellow) and nongonococcal urethritis (may be clear or white).
• Penile discharge may also be a symptom of other conditions such as proctitis, prostatitis, or epididymitis.
• Penile lesions may be a symptom of genital infection from STDs or other conditions.
• Penile discharge or lesions should be assessed to determine the possibility of genital infection from STDs.
• Risk of prostate cancer increases sharply with each advancing decade after 50 years, and probability of diagnosis rises by age group, from 2.4% in men 40 to 59 years, to 6.5% in men 60 to 69 years, to 12.5% in men 70 years and older.
• Excluding skin cancer, prostate cancer is the leading cancer diagnosed in U.S. men, and the second leading cause of death in men.
• Incidence rates of prostate cancer are significantly higher in African-American men than in Caucasian men, occurring at an earlier age and more advanced stage in African-American men.
• The optimal approach to prostate cancer screening remains controversial, with the U.S. Preventive Services Task Force finding insufficient evidence to recommend for or against routine screening using prostate-specificantigen (PSA) testing or digital rectal examination (DRE), primarily because of mixed evidence that early detection improves health outcomes.
• The American Cancer Society recommends combining DRE with testing for PSA beginning at 50 years, while the American Urological Association recommends beginning screening at 40 years.
• Men with symptoms of prostate disorders such as incomplete emptying of the bladder, urinary frequency or urgency, weak or intermittent stream or straining to initiate flow, hematuria, nocturia, or even bony pains in the pelvis should be referred to a urologist.
• Men, especially young men, should perform monthly testicular self-examinations and seek physician evaluation for any painless lump, swelling, or enlargement in either testicle, pain or discomfort in a testicle or the scrotum, a feeling of heaviness or a sudden fluid collection in the scrotum, or a dull ache in the lower abdomen or the groin.
• Men older than 70 years are at greatest risk for testicular cancer, which is low in incidence but has an excellent prognosis when detected early.
• Approximately 15% of men diagnosed with prostate cancer have an affected first-degree relative, and rare autosomal dominant alleles appear to contribute to early-onset prostate cancer.
• A series of studies suggests an association between intake of dietary fat, especially saturated fats and fats from animal sources, and risk of prostate cancer, but the evidence remains inconclusive.
• The prostate gland wraps around the urethra, and if it enlarges due to benign prostatic hyperplasia (BPH) or cancer, the patient may experience urinary symptoms.
• Hernia pain and swelling are more likely to occur when internal abdominal pressure increases, such as when lifting.
• Risk factors for testicular cancer include cryptorchidism, a history of carcinoma in the contralateral testicle, mumps orchitis, an inguinal hernia, or a hydrocele in childhood.
• Both the American Cancer Society and the American Urological Association recommend beginning screening at 40 years for African-American men and men with a positive family history.