Below the Belt

Women’s midlife changes get the lion’s share of press, but men in their 40s and 50s also have plenty of changes and concerns to contend with. Urologist Mitchell C. Benson, MD, of ColumbiaDoctors, shares some of the most common sexual and urological health concerns of middle-aged men.

Prostate Cancer 

“Before PSA testing became available in the late 1980s and early 1990s, the first sign of a prostate problem was often ‘my back hurts,’” says Benson. “After PSA tests, metastatic prostate cancer virtually disappeared; the death rate has dropped significantly.” Benson recommends that all men with a family history of prostate cancer “request a PSA test if you’re over 40. And every man over 50 should be tested. Prostate cancer is a spectrum of diseases. If you have prostate cancer, get a second opinion, to see if you need treatment.”

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Erectile Dysfunction  

As men age, their erections tend to weaken,” says Benson. “It’s not something people like to talk about, but it is reality. Viagra can significantly improve sexual function in men and give them stronger erections. It’s a cascade of treatments. If the pills don’t work, the next class is injections directly into the penis. Either a prostoglandin or a mixture of drugs called phentolamine. Finally, there is a penile prosthesis, which is most often used on younger men who’ve been made impotent by prostate cancer.”

Enlarged Prostate  

“As men get into their 50s, prostate glands benignly enlarge,” says Benson. “This enlargement, an extremely common condition also known as benign prostatic hypertrophy, can cause an urgency to urinate, to have to go at night.” There are multiple nonsurgical treatments that can improve the symptoms. “Think of a golf ball wound with rubber bands. In some men, the rubber bands are too numerous and this compresses the urethral channel. In other men, the bands are just too tight.” There are two classes of medications that can help, says Benson. “One shrinks the number of bands, and one relaxes the compression. The one that shrinks is Proscar (5 mg). The class of drugs that diminishes tension is called alpha blockers, and there are several.” 


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