Sex, Sleep or Scrabble

by Hammond, Phil

  A common symptom in women is bleeding in the middle of the cycle because the cervix is inflamed. Even more common is not to have any symptoms, so the only way to know if you’ve got Chlamydia is to get tested. The tests are really simple and accurate – women can do their own vaginal swab; blokes just pee in a pot and you can ask to have the results texted to you if you like. In the UK, anyone aged fifteen to twenty-four is offered annual Chlamydia screening for free, without needing to be examined and the results aren’t announced in school assembly. To find out where to get a test, go to www.chlamydiascreening.nhs.uk/ or phone 0800 567 123.

  Chlamydia is more common in those under twenty-five but the effects of untreated infection can hit you much later. Thirty years ago, doctors in liberal Sweden recognised the dangers of Chlamydia by screening for the disease, educating the public and tracing and treating the contacts of those infected. The incidence of pelvic inflammatory disease fell to a sixth of its former level. In Britain, research into Chlamydia has been starved of resources and screening came in much later. We may have pioneered IVF, but if just a fraction of the resources had been channelled into preventing infertility instead, far fewer women would have need for it, and those who did might get it fairly.

  Can you get crabs on your eyebrows?

  Yes. And eyelashes, moustache and any hair that isn’t too dense (chest, armpit, thigh and, of course, pubes) The French, who are very good at not making a fuss over such trifles, call crabs ‘papillons d’amour’ or butterflies of love. As in ‘Ooh look. You’ve got a butterfly of love on your moustache. How sweet!’

  Crabs can’t hop, skip or jump, so they’ll be no use in the Olympics. They can’t fly or swim either. They hide in bushes, get from one person to another by bodily contact and are remarkably hardy (they’ve been found on 4,000-year-old mummies)

  Crabs itch, especially at night and at 2mm across, they’re just visible to the keen eye. If you think you’ve spotted one, catch it and look at it under a magnifying glass. All the legs emerge from the front of the body but the clincher is the middle and hind legs which have pincer-like claws. Hence the name.

  Crabs are the ultimate idlers. They cling onto hairs and hardly move during daylight, transferring to another hair at night. You can buy a lotion such as Derbac M over the counter. Apply over the whole body from the neck down even if only your pubes are itching. Don’t put it on your eyebrows or use it if you’re pregnant. The lotion stays on overnight and if you repeat in seven days, you should take out any newly hatched eggs. Putting underclothes and bed linen through a hot wash is worth a shout too.

  If you want the opinion of a crab expert, you want screening for other infections or you want a free prescription, go to a sexual health clinic. If you’re feeling brave, ask to see the full glory of a magnified crab.

  Notes

  *1 The reverse wheelbarrow is too hard even for the Kama Sutra.

  *2Other beers are available

  5

  Body talk

  Can you really die of embarrassment?

  Yes. Cancer can pop up in the most embarrassing places but the sooner you seek help for blood, lumps, sores, pain or weight loss, the better. Many cancers are now curable but only if you come forward to be cured. I once met a man who let his testicle swell to fifteen centimetres – larger than a grapefruit – because he was embarrassed at having a lump down there and, as it got bigger, he was worried that his GP would think he was an arse for sitting on it for so long. It wasn’t until it really pressed on the nerve endings that he sought help. He survived his cancer but lost a testicle that might well have been saved if he’d come earlier.

  The cycle of delay caused by embarrassment, fear, stoicism and misplaced optimism is common throughout medicine. It causes huge suffering and occasionally death, and isn’t always easy to predict. Some people are ashamed at having a dose or shy about revealing a breast lump or rectal bleeding. Dandruff, warts, halitosis, prominent ears, acne, burst condoms, incontinence, dribbling, man boobs, excessive sweating, hairiness, impotence, cotton buds stuck in the ear, golf clubs stuck in the rear … just about any problem you care to name, someone’s delayed getting help for fear of the reception.

  Receptionists are much friendlier than they used to be and doctors and nurses should be beyond embarrassment. We’ve seen it all. At least twice. These days I only turn pink after sex or if I fall asleep in the sun (hence the nickname Salmon Hammond). Check it out on a website first (www.embarrassingproblems.com is a good start), then go and show it to a doctor. Or that nice smiley nurse.

  Do I have to lie on my left-hand side, draw my knees up to my chest and take a few deep breaths?

  No. Seeing a doctor with an anal problem (yours not his) is generally far more embarrassing for you than him. He (or she) will have heard about and seen dozens of anuses and shouldn’t be the least bit fazed. He should listen to your story and acknowledge your concerns before leaping in with the gloves and jelly. You can take a friend in with you (choose wisely) or ask to have a chaperone present. If you don’t want to be examined, it’s fine to say so. If you don’t want to be examined on your side, tucked up and facing the wall you could ask to try standing up and leaning forward.

  Slow deep breathing with your mouth open helps relax your sphincter enough to allow a finger in, and with a gentle approach and plenty of lubrication, it should slip in quite easily. We start by parting the buttocks slightly to look around the opening for piles, tags, warts or cracks in the anal wall. Then the fingertip is pressed gently at the anal opening until it relaxes and in we go. It’s not unheard of for the end of the doctor’s tie to slip in too, but that’s generally a mistake you only make once. Hopefully, you also throw that particular tie away. Doctors probably shouldn’t wear ties at all – they carry all sorts of germs and the visual image of a doctor sweeping a tie over his shoulder prior to an intimate examination can stay with you for life.

  It’s quite hard for us to see your face in either position, so if it’s painful say so. We tend to rotate the finger once it’s in to feel all around. One of my consultants used to say: ‘If you don’t put your finger in it, you’ll put your foot in it.’ He wasn’t being literal, but pointing out that a rectal examination is very useful for picking up rectal and prostate cancer. Sometimes a bit of poo pops out on the glove, but that’s actually quite useful for us to check if there’s any blood in it. Then it’s a quick wipe, a chat about the findings and a trip to the loo or the nurse on the way out if you need to offload.

  FOR HIM

  Can you check your own prostate?

  In theory, yes, but you need a long finger and some lubrication, leaning slightly forward in the shower. The prostate can be felt through the front wall of the rectum and is normally quite smooth and a bit squidgy (although not unpleasantly so). It has a central groove and should be roughly the same size either side. Any hard lump or obvious asymmetry needs checking out, although it isn’t always cancer. Now wash your hand. Some American websites advocate self-examination of the prostate but I’ve never met a man who’s admitted it. Most don’t even get as far as their testicles.

  If you want to do a fingerless check-up, search Google for the International Prostate Symptom Score. It’s a great game to play down the pub when they’ve lost the cribbage board. All the questions are about your bladder habits over the last month. I’ve paraphrased slightly:

  • How often have you had a sensation of not emptying your bladder completely after you thought you’d finished?

  • How often have you had to urinate again less than two hours after the last time?

  • How often have you found you stopped and started several times during a performance?

  • How often have you found it difficult to hold out against the desire to pee?

  • How often have you had to push or strain to get the party started?

  Score each of these either 0 (not at all), 1 (less than 1 time in 5), 2 (less than half the time), 3 (about half the time), 4 (more than hal
f the time), 5 (almost always). The bonus question, for which you’re allowed to phone your wife, is: Over the last month, how often did you typically get up to pee during the night from the time you went to bed to the time that you normally get up? (Score a mark each).

  There’s clearly an element of subjectivity here, but 20 or over is a very high score (and anything over 9 is worth sharing with a doctor). If you need some tie-breakers, try ‘where is your prostate?’, ‘what does it do?’, ‘how does it interfere with your flow?’ and ‘where’s that bloody cribbage board?’

  A doctor may want to do the finger thing, even if you’ve done it yourself, and you may be referred for uroflowmetry. It sounds technical but it just measures how quickly you pee into a pot. You can do this at home (or in the pub, but probably best in the gents, or at least the snug.) You need a measuring jug and a stopwatch. (NOTE: A lot of men suffer from bashful bladder, and so a grand pee-off along the urinal may confuse those who have prostate problems with those who are just shy.)

  Here’s what you’re measuring:

  • Start to finish times for actual peeing and trying to pee but nothing much happening;

  • The volume of pee;

  • The time it takes for you to get into full flow;

  • Divide your pee volume by your flow-time to get your average speed.

  Like a fast car, a young man should hit top acceleration within seven seconds and offload around 400 mls in twenty seconds. Anything consistently under 250 mls or over 75 seconds suggests a hold up. As does someone knocking on the door and asking ‘are you alright in there?’

  Uroflowmetry has a couple of advantages over DIY. It measures the peak flow-rate (anything over 15 ml/sec is very good, but hard to accurately judge yourself unless you switch to a second jug for your best second). Also it’s less likely to interfere with the baking.

  If all this is a bit anal, just consider how much your peeing is pissing you off. If it causes you discomfort, embarrassment, annoyance and marital conflict, and stops you doing something you might enjoy (e.g. going to a football match), then get it checked. Either drugs or surgery (or both) can make a huge difference. The same applies to women (not the prostate bit, obviously, but the getting help for leaking or dribbling. It happens to most people who’ve pushed out a nine-pounder or two).

  Is it possible to have a prostate examination without getting an erection?

  Yes. Some men enjoy prostate massage as part of their daily routine, or perhaps just a special treat on high days and holidays, but in a medical setting, the digital assessment of prostate size with you lying on your side, knees tucked up and trying not to fart doesn’t seem to reach the erection centre of the brain. And if it did, the doctor is generally too preoccupied or polite to notice.

  Is it true that tomato ketchup reduces your risk of prostate cancer and how should I apply it?

  There’s some evidence that two or more servings a week of red fruits containing lycopene – tomatoes, watermelons, red grapefruit and guava – can reduce your risk of prostate cancer by up to a quarter. The even better news is that you take them orally. Cooked or processed tomatoes are even more lycopene-rich and ketchup is an excellent sauce source (although it can be heavy on the sugar and salt). Oily fish three times a week has an even more impressive effect (up to forty-five per cent in the lowering of risk) but generally only Inuit people eat that much. Other possible prostate fillips include selenium (in grains, fish, meat and poultry), soy products and vitamin E.

  Is dribbling a sign of prostate cancer?

  It never used to be. When I trained, I was taught that cancer occurred towards the outside of the gland (and could often be felt with a finger) and benign enlargement occurred in the centre, pressing on the urethra as it passes through and causing dribbling/ poor stream/stains on light summer trousers/getting up three times a night/separate bedrooms and eventually divorce. Not benign at all, really.

  We now know that up to fifteen per cent of cancers also occur in this middle zone, so if you take your dribbling to the doctor (which is a good idea, because there are drugs that can help), she may well suggest a PSA blood test to assess the risk of cancer (either before or after the finger, depending on what sort of day she’s having).

  Is there anything more painful than a prostate biopsy?

  Yes. A prostate biopsy without anaesthetic. And probably childbirth, though it’s rare to endure both. Prostate biopsy is generally suggested for those who have suspicious finger-findings or a raised PSA blood test. It’s done when you’re fully conscious, but make sure they put a large squirt of local anaesthetic in first and give you antibiotics before and after to reduce the risk of infection. You’ll also need a bit of time for the anaesthetic to kick in.

  A well-equipped hospital will have an automatic biopsy gun guided by a transrectal ultrasound probe (yes, it goes in through the anus again). Around 8–14 biopsies are taken, depending on the size of your prostate, and – not having had the procedure myself – I only have patient accounts to go on. Some men find it bloody painful, some find it mildly uncomfortable. I suspect the difference lies both in the anaesthetic and the technique. If the doctor has trouble getting the gun out of the holster, ask if he’s done it before. Or just grit your teeth and remember: most men who have the biopsy don’t have cancer.

  How can I tell if my prostate cancer is a pussycat or a tiger?

  Other than naming it yourself, we don’t yet know which cancers will just curl up in your prostate, purr and do you no harm at all, and which will go on the rampage. We know from post-mortems that eighty per cent of men who reached eighty years of age had a pussycat cancer in their prostate that never did them any harm at all. On the other hand, tiger cancers are second only to lung cancer as a killer of men over fifty.

  We are slowly getting better at telling the pussies from the tigers. How quickly your PSA blood level changes over time is helpful, and there’s a new molecular marker called PCA3 measured from cells in the urine that seems to be a more specific and sensitive marker than the PSA test (which was once dubbed ‘Promoting Stress and Anxiety’ because it isn’t that accurate). The downside of PCA3 is that you have to collect the urine sample immediately after a prostate massage, so you’ll need a full-ish bladder, a willing health professional, a sense of humour and a pot to hand. Other genetically based tests are apparently in the pipeline.

  Does anyone else have a hole on the underside?

  Yep. 1 in 300 men are born with a penis hole in the wrong place (hypospadius), usually on the underside. If it’s picked up in childhood, it can be completely sorted by a specialist (i.e. someone who does a lot of penis reconstruction, rather than someone just having a go). But it’s not uncommon for parents to miss it and boys to get used to peeing on the floor or sitting down to pee. And because men don’t generally compare penises with each other or ask a doctor to check it over, it’s often a woman who just happens to be down that way who spots things aren’t quite right. As an adult, a repair is still possible but may not be essential, depending on exactly where the hole is and whether you’ve got a funny foreskin or a bent shaft too. Ask your GP to refer you to a specialist who can show you before and after photos.

  Oh, and if a friend ever asks: ‘Does anyone else have a hole on the underside?’, don’t pretend you didn’t hear or laugh or make him show you in the middle of a crowded bar. Just direct him to a GP or to this page.

  What makes a bladder bashful?

  At least one in ten men find it hard to pee with others looking on (even if it’s sideways from ten feet away). The longer the queue, the more the performance anxiety kicks in and the less chance you’ll get a cubicle because of all the other poor sods with bashful bladders in search of privacy. The longer you loiter at the urinal, the longer the sideways glances, until you give up and sit through the second half in torture (or nip out half way through, and miss the only goal of the game).

  Researchers have shown, in a rather dubious experiment, that if you put a stranger
next to you when you pee, it inhibits most men (more so, the closer the stranger gets). Family seem to have a less inhibitory effect (unless it’s your mother-in-law or you discover that your teenage son now has a larger penis than you do). According to The Lancet, mammals mark their territory by urinating and leaving a scent, and some men subconsciously worry that peeing in the presence of another man asserts supremacy over his territory and challenges him to a fight. In my experience, this only happens if you piss on someone by mistake.

  The cures are fairly obvious. Deep breathing, doing mental arithmetic or pretending you’re a miniature man crawling around the cracks in the toilet tiles. Works for me.

  Can you still write ‘cello scrotum’ on a sick note?

  Not any more. After ‘bad back’ and ‘a bit of a bug’, cello scrotum was until recently my top sick note diagnosis. It was first described in 1974 by Dr (and now Baroness) Elaine Murphy as an addition to ‘guitarist’s nipple’, a mild irritation caused by the rubbing of the instrument against the upper torso after vigorous plucking. If a guitar can chafe up above, why not a cello down below? In 2009, Baroness Murphy admitted that the condition was a hoax; just a bit of a joke. But not for the thousands of people who’ve lived with the condition for thirty-four years.

  As anyone who’s owned a cello can tell you, you’d need a highly unusual playing position (or a very large hernia) to cause abrasion down below, but it is possible to cause a freak ‘kebab’ injury by slippage of the spike on a cold tile floor. Most of the people I’ve labelled with cello scrotum over the years don’t possess a cello. Or even a scrotum. But the point about diagnostic labels is that they aren’t just there to make a diagnosis but to help the recipient luxuriate in the full glory of the sick role. Just as a lot of people who develop tennis elbow don’t play tennis and most of those with clergyman’s knee aren’t clergymen, we use a fancy diagnosis to spice up a boring one and big up the suffering. If you come to me with a sore shoulder, and I say ‘you’ve got a sore shoulder’, what use is that? But if I label you with ‘pitcher’s cuff’, you’ve got out of sex, work and the washing up for a fortnight.