In the UK, diseases of the heart and circulation (cardiovascular disease), including heart attacks and stroke, are the main causes of death. Nearly 1.4 million men have coronary heart disease in the UK and around 50,000 men in England alone have a heart attack each year.
There are lots of things you can do to help prevent cardiovascular disease including:
- stopping smoking
- doing regular physical activity
- eating a healthy, balanced diet including five portions of fruit and vegetables a day
- maintaining a healthy weight
- not drinking more than the recommended amount of alcohol
- getting your blood pressure and cholesterol level checked and treated if necessary
- controlling your blood glucose, blood pressure and cholesterol levels if you have diabetes
Generally, if you have any pain or tightness in your chest that feels worse when you do physical activity, contact your GP. If you get sudden crushing pain or heaviness in your chest that won’t go away, it may be a sign of a heart attack and you should call for medical help immediately.
Only men have a prostate gland. It’s about the size of a walnut and located just below your bladder. Your prostate surrounds your urethra (the tube that allows urine to pass out of your body). It produces a fluid that is mixed with sperm during ejaculation.
Benign enlarged prostate (benign prostatic hyperplasia)
Your prostate gland tends to get bigger with age and this can push on your urethra, interfering with the flow of urine. This condition is called benign prostatic hyperplasia. It’s sometimes also referred to as benign prostatic enlargement (BPE). It isn't cancerous. About half of men over 50 get symptoms of BPH.
- having difficulty passing urine
- having a weak flow of urine that sometimes starts and stops
- dribbling of urine before or after urinating
- feeling that you haven't completely emptied your bladder after passing urine
- a frequent or urgent need to pass urine
- needing to get up several times in the night to pass urine
These symptoms may also be caused by problems other than BPH. If you have any of these symptoms, see your GP for advice.
Sometimes an enlarged prostate may be just a minor nuisance and won’t affect you too much. But if it’s bothering you, it can have a big impact on your life. Depending on how severe it is, your treatment options may include making simple lifestyle changes, taking medicines and having surgery. Having an enlarged prostate doesn’t increase your risk of getting prostate cancer.
In the UK, around 40,000 men are diagnosed with prostate cancer each year and the majority are over 70. Your risk of getting prostate cancer is higher if a close relative, such as your father or brother, has had it.
There is no national screening programme for prostate cancer in the UK. A PSA test – a blood test that measures levels of a protein called prostate specific antigen (PSA) is available. This may be worth considering if you’re over 50 years old. However, the test isn't recommended for everyone and you need to discuss the pros and cons first with your GP.
There is uncertainty over whether its benefits outweigh the potential harm it may cause. For example, this may lead to unnecessary investigation and treatments for slow growing cancers that wouldn’t have caused any harm. A raised level of PSA can also be caused by other conditions, such as an enlarged prostate or a urinary infection. In fact, two out of three men who have raised PSA levels don’t have prostate cancer.
Prostate cancer can press on your urethra and block the flow of urine, producing symptoms similar to those of BPH. These symptoms aren't always caused by prostate cancer but if you have them see your GP.
Treatment for prostate cancer depends on a number of factors, including your age, general health and the stage and grade of your cancer. For example, you may be offered monitoring such as watchful waiting or active surveillance. These mean you will be closely monitored but won’t have treatment. They are slightly different so discuss them with your doctor. Monitoring may be offered to you because prostate cancer is often slow-growing and you may not need to have other treatment.
Prostate cancer may also be treated with surgery, radiotherapy or hormone therapy. For more information about how prostate cancer is monitored and treated, see our factsheet.
All men should examine their testicles regularly to check for anything that isn’t normal for them. As a general guide, if you notice any changes such as swelling, lumps, hardening or pain in your testicles, see your GP.
If your testicle becomes twisted (this is called torsion) you will have severe pain and swelling. It occurs mainly in teenage boys aged between 13 and 17 and rarely in men older than 30. The pain develops quickly and you may also feel sick and vomit. Unless testicular torsion is treated within a few hours, it can cause permanent damage that can lead to fertility problems. Testicular torsion is usually treated with surgery.
Testicular cancer is rare – about 2,100 men are diagnosed in the UK each year. However, it’s the most common cancer in men aged between 20 and 34 years old. Symptoms usually include having a painless lump or a feeling of heaviness or discomfort in your scrotum. If you find a lump, or are concerned about changes in your scrotum, see your GP. Going sooner rather than later can make a significant difference. Your GP may refer you for further tests or a biopsy.
Treatment options for testicular cancer will depend on the type of tumour you have and its stage, but options may include surgery, radiotherapy or chemotherapy. Most types of testicular cancer can be treated successfully with early treatment.
Erectile dysfunction is the ongoing inability to achieve or sustain an erection for sexual activity. The likelihood of you having erectile dysfunction increases as you get older. There are many different causes of erectile dysfunction, including:
- cardiovascular disease (diseases that affect your heart and circulation)
- high blood pressure and high cholesterol levels
- surgery affecting the blood vessels or nerves that supply your penis
- certain medicines, including some antidepressants and some medicines for high blood pressure such as beta blockers
- psychological problems such as anxiety and depression
- tiredness, illness or stress
- smoking or drinking too much alcohol
There are several treatments for erectile dysfunction. Sometimes, lifestyle changes such as reducing how much alcohol you drink can help. Your GP will also advise you to lose excess weight, stop smoking and increase your physical activity. Medicines that you take orally, such as sildenafil (Viagra), are effective in treating forms of erectile dysfunction caused by the narrowing of the blood vessels. There are other medicines available that you inject into your penis. However, these medicines aren't suitable for everyone and can have side-effects.
If medicines are not suitable or don’t work there are other treatments available such as vacuum pumps, and surgery. Talking therapies, such as counselling may be recommended if your condition is caused by anxiety or stress. Your GP will be able to discuss the most suitable treatment options for you. As erectile dysfunction can often be a sign of cardiovascular disease, your GP may suggest you have some tests for risk factors. These may include checking your blood pressure, cholesterol and blood glucose (sugar) levels.
How do I examine my testicles?
It's important to check your testicles regularly so that you know what is normal for you and you can notice any changes. There isn't a set way to examine your testicles and everyone is different, but the explanation below may help.
It's a good idea to check your testicles when you feel comfortable and have a bit of time to yourself. For example, you could check them when you’re lying in the bath or are having a warm shower. This may be a particularly good time as the skin of your scrotum is relaxed and your testicles will be easier to examine.
Get used to the weight of your testicles by holding your scrotum with your hands. One testicle often hangs lower than the other, so you don’t need to be concerned about this. Your testicles should feel smooth and you can roll them between your fingers and thumb. At the top and back of each testicle is a small tube called the epididymis. This feels like a soft coiled tube and is normal. You should also be able to feel the smooth, firm cord-like tube of the spermatic cord that runs up from the epididymis.
As a guide, you should visit your GP if you notice:
- lumps or swelling
- pain or discomfort
- a testicle that feels hard
- heaviness in your scrotum
- aching in your abdomen, scrotum or groin
- anything else that you think is unusual
It’s important to get to know what is normal for you and how each testicle feels. If you need more information, see your GP.
I'm worried that I've caught a sexually transmitted infection (STI). What should I do?
If you think you may have caught an STI, go to a sexual health clinic for a test or see your GP.
Most STIs can be treated effectively. But it’s important to get yourself checked out as soon as possible and get yourself and your partner(s) treated if necessary. This should help clear up any infection you may have before it gets worse, or you pass it on to someone else.
If you have an STI, you may have symptoms that include:
- an unusual discharge from your penis
- pain or a burning feeling when you pass urine
- pain in your testicles
- itching around your penis, anus or the surrounding area
- a rash, sore, lump or blister on or around your genitals or anus
Using a condom provides effective protection against most STIs. It's also important to go for regular STI screening tests if you change sexual partners often.
Is it safe to buy treatments for erectile dysfunction over the internet?
Be careful if you're considering buying medicines on the internet, particularly prescription-only medicines. If you do, there is a risk that they may be from unregulated or illegal websites. If they are, there will be no guarantee of safety, quality or effectiveness.
Erectile dysfunction can have a number of causes and so it’s best to discuss with your GP what treatment options are most suitable for you. You may not need to take medicines – for example, sometimes lifestyle changes such cutting down on the amount of alcohol you drink can help. But if you do need medicines, always get them prescribed by your GP.
If you buy medicines over the internet, there is a risk that they may come from unregulated or illegal websites. If they do, there will be no guarantee of their safety, quality or effectiveness. This may be particularly dangerous if you buy an oral medicine such as sildenafil. It can interact with other medicines you may be taking and can have serious side-effects. Also, medicines that you can buy online may not contain the right ingredients and have no effect. In the worse case, these can be harmful to you.
Pharmacies in the UK that are registered with the Royal Pharmaceutical Society of Great Britain can display a logo on their website. It’s important to remember that if you buy medicines online, you won’t have the benefit of a face-to-face consultation with a healthcare professional. You may also risk buying medicines that aren’t suitable for you. Remember that information that you discuss with your GP will be kept confidential.
I think I might be depressed. What can I do?
If you think you may be depressed, try to tell someone about your feelings and make an appointment to see your GP.
Depression is a condition in which you may have low mood, a loss of interest in everyday activities and feelings of low self-worth. You may also have a lack of energy and poor memory and concentration. All of these symptoms can last a long time.
If you have depression, you may have a number of different symptoms including:
- feelings of hopelessness, worthlessness and guilt
- finding it hard to concentrate,
- worrying about things more than you usually would
- a loss of interest in sex
- finding it difficult to get to sleep and/or waking up in the night or early in the morning
There are some symptoms of depression that are particularly common in men. For example, if you’re a man with depression, you’re more likely to be irritable, with outbursts of anger or aggressiveness. You may also throw yourself into work to escape difficult emotional issues, or take risks, including misusing drugs or alcohol.
If you think you might be depressed, try to tell someone about your feelings and make an appointment to see your GP. You can help yourself by trying to stay active, as regular physical activity can help to improve your mood. Don’t drink alcohol excessively as this may make you feel worse in the long run. Your GP may suggest you try a talking therapy, such as counselling or psychotherapy. If your depression is more severe, he or she may prescribe antidepressants to help your depression.
- Cardiovascular disease statistics. British Heart Foundation. www.bhf.org.uk, accessed 12 December 2013
- Enlarged prostate. Prostate Cancer UK. www.prostatecanceruk.org, published January 2013
- Prostate cancer. NICE Clinical Knowledge Summaries. cks.nice.org, published January 2011
- Prostate cancer: diagnosis and treatment. National Institute for Health and Care Excellence (NICE), 2014. www.nice.org.uk
- Guidelines on prostate cancer. European Association of Urology. www.uroweb.org, published 2013
- Prostate cancer. Prostate Cancer UK. www.prostatecanceruk.org, published January 2013
- Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 464–77, 774–5, 998–1003
- Guidelines on testicular cancer. European Association of Urology. www.uroweb.org, published 2012
- Scrotal swellings. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2010
- Erectile dysfunction. The Merck Manuals. www.merckmanuals.com, published November 2013
- Alcohol and men. DrinkAware. www.drinkaware.co.uk, accessed 12 December 2013
- Real danger. Royal Pharmaceutical Society. www.rpharms.com, accessed 12 December 2013
- Sexually transmitted infections (STIs). FPA. www.fpa.org.uk, accessed 12 December 2013
- Testicular self-exam. American Cancer Society. www.cancer.org, published 5 November 2013
- Depression and men. Royal College of Psychiatrists. www.rcpsych.ac.uk, published October 2013
- Testicular cancer. Macmillan. www.macmillan.org.uk, accessed 9 January 2014
- Cardiovascular risk assessment and management. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2008
- Risk factors and causes of prostate cancer. Macmillan. www.macmillan.org.uk, published 1 May 2012
- Prostate cancer risk management programme questions and answers. Public Health England. www.cancerscreening.nhs.uk, accessed 9 January 2014
- Drugs for erectile dysfunction. British National Formulary (online). www.medicinescomplete.com, London: BMJ group and Pharmaceutical Press, accessed 9 January 2014 (online version)
- Sildenafil. British National Formulary (online). www.medicinescomplete.com, London: BMJ group and Pharmaceutical Press, accessed 9 January 2014 (online version)
- Diabetes, heart disease and stroke. National Diabetes Information Clearing House. diabetes.niddk.nih.gov, published August 2013
- Type 2 diabetes. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2010
- Diabetes. British Heart Foundation. www.bhf.org.uk, accessed 14 February 2014
- Chest pain of recent onset. National Institute for Health and Care Excellence (NICE), March 2010. www.nice.org.uk
- Chest pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2011
- Lower urinary tract symptoms. National Institute for Health and Care Excellence (NICE), 2010. www.nice.org.uk
- Prostate symptoms. The British Association of Urological surgeons. www.baus.org.uk, accessed 14 February 2014
- Guidelines on the management of erectile dysfunction. British Society for Sexual Medicine, www.bssm.org.uk, published July 2009
- Erectile dysfunction. NICE Clinical Knowledge Summaries. cks.nice.org, published January 2013
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