Vasectomy is one of the most common surgeries in the world, and one of the most effective: It successfully prevents pregnancies more than 99 percent of the time. It’s also quick. The surgery takes about 20 minutes.
For something so fast, the effects of a vasectomy are long-lasting, whether you want them to be or not. “You should consider it permanent contraception. Vasectomy reversal is highly successful in getting the sperm back into the ejaculate, but the chance of having a pregnancy as the result is about 60 percent,” says Marc Goldstein, M.D., professor of urology and director of the Center for Male Reproductive Medicine and Microsurgery at the New York Hospital-Cornell Medical Center in New York City. “The sperm may not function normally because of tissue damage from the vasectomy.”
More worrisome to many men these days, especially those who have already had their vasectomies, may be the reports that a link had been found between vasectomies and prostate cancer. Two studies from the Harvard Medical School claimed to have found evidence of such a link, causing a major stir in medical circles. Other studies before and since have found no association, and the World Health Organization, National Cancer Institute and the National Institutes of Health in Bethesda, Maryland, have concluded, judging from the evidence gathered so far, that the cancer connection is unlikely.
Research continues, but most doctors feel the prostate cancer scare—like an earlier scare that vasectomies might contribute to coronary artery disease—ultimately will prove to have been unfounded.
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When the discomfort is more than you’re willing to put up with, or your veins have deteriorated to the point where poor circulation causes ankle ulcers or other circulatory complications, more active measures may be called for. Taking action relatively early in the game may, for that matter, prevent more veins from going bad. There are two procedures to eliminate severely affected varicose veins: “stripping” surgery and sclerotherapy.
Both take the affected vein out of action—stripping by surgically tying it off and physically removing it, and sclerotherapy by injecting a chemical that scars the vein and makes it shrivel and die.
This step is less dire than it may sound, since the veins have become thoroughly useless by this time anyway, Dr. McDonagh points out. “There’s no blood passing through them anymore … they’re like sausages filled with blood.” Deeper veins have already taken over their duties, so removing them is “like weeding a garden.”
No treatment, however expertly it’s done, is entirely painless, and because varicose veins are chronic and progressive, the very same symptoms may reappear when other veins become involved, according to Dr. Goulet. Be wary of exaggerated claims about “permanent” and “breakthrough” techniques, the Federal Trade Commission warns.
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The same measures can make varicose veins less likely to appear at all or slow them down and relieve discomfort once they’ve started to develop.
Exercise. “Walking, biking… anything that promotes good circulation in the legs will prevent the formation of varicose veins and relieve symptoms,” says Dr. Goulet. Leg muscle contractions help return blood to the heart against the pull of gravity. Not only does exercise give veins an active assist while you’re doing it, tighter muscle tone adds continual support.
Fiber up. “You don’t want to be constipated,” says Dr. Goulet. “When you strain on the toilet, pressure in the abdomen gets transmitted to the veins of the legs.” It has been suggested that diet is the critical factor that makes varicose veins a rarity in much of the world. Make sure you eat enough fiber and drink enough water to keep towel movements soft.
Slim down. If you’re overweight, your legs—and their veins—must bear the Hurden, Dr. Goulet points out.
Work out smart. Avoid heavy weight lifting, which also heightens pressure from the abdomen downward. If you do abdominal exercises, like sit-ups, keep your legs elevated at a 30-degree angle, Dr. Goulet advises.
Be supportive. Medical support stockings, which are most snug at the ankle and progressively looser higher up on the leg, aid vein circulation more effectively than the department store variety, Dr. McDonagh says. For these, you need a prescription.
But Dr. Goulet believes that store-bought, nonprescription support hose are usually adequate if your varicose veins are fairly small. It’s best to go with professional caliber, however, if your work demands a lot of standing or sitting.
Cool it. Heat causes veins to open up, bringing more blood to the legs and keeping it there. “Avoid very hot baths and showers,” says Dr. Goulet. “A Jacuzzi is okay once in a while, but not on a regular basis.”
Shun the sun. Sunburn on your legs breaks down the supporting fiber of the veins and makes them less elastic. Just sunbathing, for that matter, dilates veins and promotes blood pooling.
Put your legs up. Particularly if they ache at the end of the day after you’ve been on your feet, sitting or lying with your legs higher than your buttocks should reduce swelling and ease pain quickly, Dr. Goulet says.
Sleep on a slant. Elevating your legs while you sleep is especially helpful if varicose veins are advanced, but may promote comfort at any stage, Dr. Goulet says. There are drawbacks: If you’re prone to heartburn, this position will make it worse.
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While a lot of men are willing to ignore varicose veins even when they’re unsightly, a lot of others can’t. In fact, up to half of the people who seek medical care report occasionally being bothered by distressing symptoms, like aching, swelling and night cramps, which are just as likely to afflict men as women.
What’s more, varicose veins needn’t be big, blue and bulging to cause distress. Small veins early in the course of the condition can cause considerable pain, too. Even spider veins generate painful symptoms 50 percent of the time, Dr. Goulet says.
If your legs ache, blame your parents. Between 80 and 90 percent of people with varicose and spider veins report that it runs in their families, says Dr. Goulet. Or blame your job: Occupations that require long periods of standing or sitting carry an increased risk.
As common as varicose veins are hereabouts, the majority of people across the globe—in developing countries, in particular—rarely get varicose veins. And this is hard to pin on genes. While Africans are rarely afflicted, African Americans get them as often as white Americans, suggesting lifestyle plays a role.
By the time you see varicose veins, the process has been underway for some time, says Brian McDonagh, M.D., founder of Vein Clinics of America in Schaumburg, Illinois. “It’s a condition that’s out of sight for most of the time it’s developing. What you see is the tip of the iceberg.”
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How common: An estimated one- to two-thirds of American adults have varicose veins. According to a U.S. Health Survey, it’s the seventh most common chronic disease. All counts are rough, however, since men often don’t see a doctor when a minor case breaks out.
Risk factors: Advancing age, prolonged standing at work, family history.
Age group affected: Varicose veins are progressive. They’re seen in 20-year-olds (and even children), but grow more common with age.
Gender gap: The incidence of varicose veins is roughly five times as great in women than in men.
Who to see: Dermatologists, vascular surgeons and phlebologists (vein specialists) treat varicose veins. It may be best to get more than one opinion.
On the scale of/men’s medical worries, varicose veins rank pretty near the bottom. We tend to think of “road map legs” as a women’s thing, and one that won’t surface till late in life.
While it’s true that varicose veins are more than twice as common in women, the problem is so widespread—an estimated 30 to 60 percent of American adults have it—that it still affects quite a few guys.
And although varicose veins grow progressively worse with age, they often start early. “I see it in men in their twenties, thirties and forties,” says Conrad Ooulet, M.D., director of the Guylaine-Lanctot Clinique in Palm Beach Gardens, Florida.
Where do they come from? The veins in the lower body are lined with valves that help blood return to the heart against the pull of gravity. “When the wall of the vein becomes slack, the vessel dilates and the valves don’t close entirely,” says Dr. Goulet. “Blood flows backward and pools in the veins.” The same process in smaller vessels creates little webs of “spider veins.”
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How common: More than six million men have incontinence problems. Major medical problems are far rarer.
Risk factors: Smoking and working with certain industrial chemicals put you at risk for bladder cancer. Prostate enlargement and similar problems put you at risk for incontinence and other disorders. Promiscuity can put you at risk for a urinary tract infection caused by a sexually transmitted disease. Psychological causes can prompt bashful bladder syndrome.
Age group affected: Urinary conditions can affect men of all ages. Men over age 50 and men with prostate problems suffer more from incontinence and other urination disorders. Younger men have more infections because of sexually transmitted diseases.
Gender gap: Men and women both can have urinary problems, but some conditions, like bladder cancer and bladder stones, almost exclusively affect men.
Who to see: Urologist.
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Watch ol’ yellow. The color of your urine varies with whatever you’ve consumed. But if you’re not getting enough water, then you’ll see bright yellow urine, a sign that it’s too concentrated. “This especially is important in the summer or when you’re working outdoors because of dehydration,” Dr. Nadig says. “If you’ve had stones, keep your urine from getting yellow.”
Empty the tank. Fully empty your bladder when you urinate, and if you drink frequently, make sure to urinate frequently, too. This prevents the chemical compounds in urine from binding. By drinking lots of fluid and passing all your urine, “you’ll be washing out the stone crystals rather than giving them a chance to form together,” adds Dr. Tanagho.
Bashful bladder: A bashful bladder is when you’re unable to pee in public. It’s a psychological problem rather than a physical one, yet bashful bladders can traumatize guys who like concerts, football games or other events where urinating in close quarters is common. Although bothersome, bashful bladders aren’t usually dangerous. Here’s how to fix the problem.
See the pros. First see a urologist to make sure there’s no physical cause for your bladder’s shyness.
Stall for time. Yup, this is an obvious one. Instead of vainly trying to use a urinal, wait for a stall. For busy rest rooms, strategically plan your pit stops to avoid rush hours, like the intermission between a play or halftime at a football game.
Consider drugs. One drug that’s been used for patients with bashful bladders is urecholine (Benthanechol), which stimulates bladder emptying. Since it’s not always effective, talk to your doctor about this and other options.
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Doctors treat bladder cancer with surgery, chemotherapy, radiotherapy and other measures. Although you can’t do much yourself once cancer is detected, you can take precautions to decrease your risk of contracting it. Here’s how.
Quit smoking. “The toxic products of smoking are excreted through the urine, and these chemicals bathe the bladder for years,” Dr. Nadig says.
Know the risks. Exposure to chemicals causes 15 to 35 percent of all bladder cancer cases in men. The culprits include benzidine, beta-naphthylamine and 4-aminobiphenyl. They’re found in the chemical dye, rubber, petroleum, leather and printing industries. If you’re unsure whether or not you’re exposed to these chemicals, find out before your bladder tells you the hard way.
Bladder stones: Experts estimate that 95 percent of all bladder stones occur in men. Symptoms include blood in the urine, frequent urination, pain, chronic urinary tract infections and dribbling.
Bladder stones are not too common nowadays—not as common as, say, kidney stones. But they may indicate an underlying medical condition. Here’s how to keep one from developing.
Water it down. Drinking lots of water helps retard the growth of urinary stones, be they in the bladder or kidneys. Dr. Nadig says men who have a history of stones should drink at least eight eight-ounce glasses a day.
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As medical conditions go, bladder problems are relatively rare. Yet some of the more pesky—and dangerous—bladder problems hit men more than women. Below are three bladder problems you should know about and tips on what to do for them.
Bladder cancer: Although uncommon, bladder cancer isn’t dead, and as a man you’re three times more likely to get it than a woman. The average age of diagnosis is 65, but an unhealthy lifestyle today could increase your chances later on. Smoking accounts for 50 percent of bladder cancer cases in men.
“Cigarette smoking is insidious. You may not get problems until 30 or 40 years later,” says Perry W. Nadig, M.D., clinical professor of urologic surgery at the University of Texas Health Science Center in San Antonio.
Symptoms include frequent and/or urgent urination and, in advanced stages, bone pain. The hallmark symptom is blood in the urine. It’s present in 85 to 90 percent of the cases.
“My main advice is anyone who passes blood in their urine without any other symptoms should immediately seek a doctor to rule out malignancy,” says Emil A. Tanagho, M.D., chairman of the urology department at the University of California School of Medicine in San Francisco and co-author of the medical text Smith’s General Urology.
Doctors treat bladder cancer with surgery, chemotherapy, radiotherapy and other measures. Although you can’t do much yourself once cancer is detected, you can take precautions to decrease your risk of contracting it.
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Check what’s in your medicine cabinet. If you’re suddenly dogged by incontinence, check your medications. Some medicines, including cold medications, antidepressants and muscle relaxants, can affect urinary control.
Plan the pit stops. You may be able to gain more urinary control if you map out a pit-stop plan. Urinate according to a regular schedule each day—every hour, for example—and gradually build up time so that you are able to postpone the need to go for two to three hours at a time. Dr. Jeter says this technique works by building bladder endurance, much like gradually increasing your running distances helps you train for a marathon.
Start a urine log. Record urination information on paper, including the day and time of every pit stop, how much you expelled, how much liquid you drank over the course of the day and whether your leakage was small, medium or large.
“I need to know this to know what’s going on,” explains Jacques G. Susset, M.D., clinical professor of urology at Brown University School of Medicine in Providence, Rhode Island. Dr. Susset suggests keeping the log for three periods of 24 hours.
To measure the flow, pee into an empty milk carton. Along the carton’s outside edge—before it’s full—mark off one-ounce increments, like a measuring cup, so you’ll know at a glance how much you’ve expelled.
Give ‘em a squeeze. Kegels are exercises that strengthen the pelvic floor muscles, including the muscles that control urine flow. Squeeze for a few seconds the muscles you use to stop the flow of urine, then let them relax. Do three sets of five daily for a week. Then gradually add 5 repetitions to each set, working up to 30 repetitions, three times a day. This should help in strengthening the pelvic floor muscles and may help control your bladder, Dr. Jeter says.
Men’s Health-Erectile Dysfunction