Transcript: Urology | Feb 11, 2002

(music plays)

A title appears inside the shape of a house: More to Life. Words spin against a red and orange background: Health, Family, Home, Money, Fitness, Life. Fast clips show images related to the previous concepts, such as a dollar bill, a wheat field, and strands of DNA.

In animation, the title appears inside the shape of a house: "More to life."

Then, Mary Ito sits in a studio with textured yellow walls and the logo of the show in the background, which reads "More to life."

Mary is in her late thirties, with short black hair and bangs. She's wearing a black cardigan, a white blouse and pearl earrings.

She says HELLO. I'M MARY ITO. WELCOME TO MORE TO LOVE WEEK HERE ON MORE TO LIFE. WITH VALENTINE'S DAYS AWAY, ITS TIME TO GET IN THE MOOD. WHAT IF YOU CAN'T? SEXUAL DYSFUNCTION AFFECTS MEN AND WOMEN ALIKE. THE BIG QUESTION IS, IS IT IN MY HEAD? WE ARE HERE TO FIND OUT. DR. RICHARD CASEY IS THE DIRECTOR OF THREE HEALTH CENTERS.

Richard is in his forties, clean-shaven, with wavy brown hair and bangs. He's wearing a black suit and shirt.

Mary continues MEN, IF YOU HAVE ANY QUESTIONS TO DAY AT ALL ABOUT PERFORMANCE, YOUR PROSTATE OR MAYBE SOME PLUMBING QUESTIONS IN GENERAL, GIVE US A CALL. LADIES, YOU MAY WONDER WHAT WOULD VIAGRA DO FOR YOU? CALL US WITH ANY QUESTIONS YOU HAVE.

A caption reads "416-484-2727. 1-888-411-1234."
Then, it changes to "moretolife@tvo.org"

Mary says HELLO, DR. CASEY.

Richard says THANK YOU FOR REMINDING ME ABOUT VALENTINE'S DAY.

Mary says I'M SURE YOU ARE BUSY.

Richard says NEVER TOO BUSY FOR THAT.

Mary says ITS IRONIC HAVING A UROLOGIST WITH RICHARD AS A FIRST NAME.

Richard says I HAVE BEEN DR. DICK THE DICK DOCTOR.

[LAUGHTER]

Mary says I WANT TO START OFF WITH SEXUAL DYSFUNCTION. TELL ME WHAT IS THE DEFINITION.

Richard says WE KNOW WHAT IT IS IN MEN. IN MEN ITS THE INABLE... INABILITY TO OBTAIN OR MAINTAIN AN E RECOGNIZE SHUN. IT USED TO BE IMPOTENCE.

Mary says ALL THE TIME? MOST OF THE TIME?

The caption changes to "Doctor Richard Casey. Urologist."

Richard says MILD, MODERATE, SEVERE. SEVERE WOULD BE ALWAYS UNABLE. MILD MAY BE OCCASIONAL. MILD MAY BE THE YOUNGER MAN, 30s, 40s, HAD TOO MUCH TO DRINK. SEVERE MAY BE 55 DIABETIC ON INSULIN WHO CAN'T GET AN E RECOGNIZE SHUN. THE TREATMENTS ARE THE SAME FOR ALL THREE GROUPS BUT THERE ARE OTHER HEALTH ISSUES WITH THE MORE SEVERE GUYS.

Mary says I WONDER WHEN YOU SAY MILD OCCASIONALLY, WOULD THAT BE CONSIDERED NORMAL FOR MANY MEN?

Richard says A LOT OF WHAT WE DO IS EDUCATE MEN WHAT THEY ARE EXPERIENCING IS NORMAL. A 30-YEAR-OLD MAN WHO HAS A FAILURE GOES TO THE DOCTOR AND MAKE AS MOUNTAIN OUT OF A MO HELL. LOTS OF TIMES, ITS JUST RELAX. READ A BOOK. TRY IT AGAIN LATER. A LOT OF IT IS EDUCATION.

Mary says I'M WONDERING ABOUT AGE AS WELL. HOW MUCH IS AGE A FACTOR?

Richard says OLDER MEN MAKE BETTER LOVERS. THINK OUR SEXUAL FUNCTION CHANGES AS WE GET OLDER. MEN HAVE MORE DIFFICULTY GETTING E RECOGNIZE SHUNS AS THEY GET OLDER BUT GENERALLY MOST FUNCTION NORMALLY IN TO THE 70s OR 80s.

Mary says DOES ALL THIS SURPRISE A LOT OF PEOPLE YOU TALK TO?

Richard says WHAT CAUSES ERECTION IS OTHER THINGS.

Mary says WHAT ABOUT FOR WOMEN?

Richard says THE INTEREST IN MALE SEXUAL DYSFUNCTION HAS SPARKED INTEREST IN WOMEN. IN WOMEN, THEY ARE MORE COMPLEX BEINGS. ITS MORE DIFFICULT TO SORT IT OUT. WE ARE RELUCTANT TO USE THE WORDS FEMALE SEXUAL DYSFUNCTION BECAUSE A LOT OF WHAT WOMEN EXPERIENCE IS NORMAL. SO WE ARE IN 2 PROCESS OF CATEGORIZING IT NOW. TO ANSWER THE QUESTION, IF YOUR SEXUAL ACTIVITY CAUSES YOU DISPLEASURE, WE CONSIDER IT DYSFUNCTION. IF THE PROBLEM WHO HAS THE PROBLEM... IF THE PERSON IS WHO HAS THE PROBLEM IS UNHAPPY, WE WOULD HAVE TO LOOK AT THAT.

Mary says YOU ARE DEFINING IT AS DISPLEASURE. THAT IS SUBJECTIVE.

Richard says IT IS. IN MEN TOO IT IS. A LOT OF THE WAY WE DEFINE IT IN CLINICAL TRIALS IS THEIR IMPRESSION OF THEIR SEXUAL FUNCTION. IF THEY ARE HAPPY, IF THE PARTNER IS HAPPY, ITS NOT A PROBLEM.

Mary says SO ARE YOU SAYING THEN IF A WOMAN HAS NO SEXUAL DESIRE BUT SHE'S NOT BOTHERED BY IT, ITS NOT A PROBLEM.

Richard says ITS NOT A PROBLEM FOR HER. IT MAY BE A PROBLEM FOR HER PARTNER. BUT IF SHE IS NOT BOTHERED, I DON'T CONSIDER IT DYSFUNCTION. OR IF SHE HAS DIFFICULTY ACHIEVING ORGASM BUT SHE IS HAPPY, ITS NOT A DYSFUNCTION. ITS WHEN IT CAUSES PERSONAL DISTRESS.

Mary says THIS AREA HAS BEEN CONSIDERED AN AREA OF EMBARRASSMENT. IT STILL IS FOR MANY PEOPLE. DO YOU FIND THINGS HAVE CHANGED FROM YOUR CLINIC AND THE PEOPLE YOU SEE?

The phone numbers and email reappear briefly.

Richard says THE PHARMACEUTICAL INDUSTRY HAS DONE A GREAT JOB OF BRINGING IT OUT OF THE CLOSETS. THE NEW VIAGRA COMMERCIAL IS GREAT. ONCE ITS OKAY TO TALK ABOUT IT, PEOPLE WON'T STOP TALKING ABOUT IT. [LAUGHTER] ITS STILL DIFFICULT WITH WOMAN. MOST OF THEIR PHYSICIANS WERE MALES. ITS DIFFICULT FOR A WOMAN TO SAY TO A MALE I'M HAVING DIFFICULTY WITH MY SEX LIFE. NOW WITH MORE WOMEN DOCTORS WHO OH DO A GOOD JOB OF ASKING THE PATIENTS, MORE IN THE NEWS, TELLING PEOPLE ITS OKAY, WE DON'T HAVE AS MUCH A PROBLEM GETTING IT OUT OF PATIENT NOW. THE INCIDENTS OF SEXUAL DYSFUNCTION IN WOMEN IS HIGHER THAN IN MEN.

Mary says WHAT ARE THE STATS ON THAT?

Richard says 43 percent OF WOMEN SOMETIME IN THEIR LIFE HAVE SEXUAL DIFFICULTIES. HAT HALF.

Mary says ALMOST HALF. I HEARD A STUDY RECENTLY I BELIEVE IN THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION ABOUT WOMEN'S SOX OF LIBIDO. IT WAS 40 PERCENT OF AMERICAN WOMEN WITH LOW SEXUAL DRIVE.

Richard says ITS A DIFFICULT ISSUE. MANY OF THOSE WOMEN HAVE RELATIONSHIP PROBLEMS, PROBABLY A RESULT OF THEIR POORLY BY DO BUT SOME HAVE PHYSIOLOGIC PROBLEMS. ITS SORTING OUT THE MEDICAL PROBLEMS FROM THE MARITAL PROBLEMS. NO SEXUAL PROBLEM IS FREE FROM HAVING MARITAL ISSUES WITH IT.

Mary says YEAH. IS IT TOO COMPLICATED TO SAY, YOU KNOW, HOW MUCH OUT THERE IS A RESULT OF PHYSIOLOGICAL PROBLEMS AND HOW MUCH IS A RESULT OF EMOTIONAL PROBLEMS IN.

Richard says I THINK WE KNOW IN MEN A MAJORITY OF IT IS ORGANIC. I DON'T LIKE USING THE TERM BUT ITS DUE TO UNDER LYING MEDICAL PROBLEMS. MOST MEN ARE HAPPY WITH A PILL. IF WE CAN FIX THE ERECTION PROBLEMS, A LOT OF CLINICS HAVE TRIED TO GET THE COUPLE IN TO TALK ABOUT IT. MEN SAY, ITS OKAY. FIX THE ERECTION, I WILL DEAL WITH MY WIFE. SO ITS NOT A COUPLE ISSUE IN MEN. IN WOMEN, IT APPEARS THERE MAY BE MORE INVOLVED. TAKE THE SUPER WOMAN GOING TO WORK, HAVING KIDS, LOOKING AFTER THE KIDS, COOKING, CLEANING, WHO WANTS TO HAVE SEX AT THE END OF THE DAY? THAT MAY INFLUENCE THEIR SEXUAL PERFORMANCE FOR SURE.

Mary says OKAY. LET'S TALK ABOUT WHAT YOU ARE SEEING IN YOUR CLINIC. WHAT ARE THE MOST COMMON TYPES OF PROBLEMS THAT YOU ARE SEEING?

Richard says WELL MOSTLY MALE SEXUAL PROBLEMS. WE ALSO SEE A LOT OF PROSTATE AND CANCER PROBLEMS. THAT WOULD BE THE BIG CONCERN FOR MEN OVER 50. ON THE WOMEN'S SIDE, WE SEE A LOT OF BLADDER PROMS, A CONDITION CALLED OVER ACTIVE BLADDER. THE WOMAN WHO KNOWS WHERE EVERY BATHROOM IS IN THE MALL.

Mary says WHAT AGE?

Richard says USUALLY IN THE 40s. UP TO 75 OR 80.

Mary says LET'S TALK ABOUT DRUGS REGARDING SEXUAL DYSFUNCTION. I HAVE HEARD ABOUT A NEW ONE, I BELIEVE ITS EX VERMT AL SIALIS?

Richard says YES. WITH THE SUCCESS OF VIAGRA WE WILL BE HIT WITH DRUGS. ITS GOING TO BE AGAINST THE LAW NOT TO PRODUCE AN E RECOGNIZE SHUN ON DEMAPPED. THE ONE YOU MENTIONED IS THE SAME AS VIAGRA. IT STAY NS THE BODY A BIT LONGER TO INCREASE THE WINDOW OF OPPORTUNITY. ONE OF THE PROBLEMS WITH VIAGRA IS YOU HAVE TO TIME YOUR SEX. MOST PATIENTS ARE ABLE TO DO THAT. VIAGRA HAS BEEN SUCCESSFUL. THERE IS ANOTHER DRUG THAT YOU PUT UNDER YOUR TONGUE THAT MAY BE RELEASE ND THE FUTURE.

Mary says THESE ARE FOR MEN OR WOMEN?

Richard says MOSTLY MEN. THE WOMEN HAVE TRIED VIAGRA. THERE ARE REPORTS THAT IT WORKS. ALSO ALSO WOMAN'S WOMEN ARE MORE SENSITIVE TO THE SIDE EFFECTS SO THAT IS STILL BEING STUDIED BY PFIZER. WE ARE A COUPLE YEARS AWAY BEFORE VIAGRA FOR WOMEN.

Mary says WHAT ABOUT THE CONTROVERSY ABOUT VIAGRA AND HEART PROBLEMS?

Richard says I CAN'T THINK OF A DRUG THAT IS SAFER THAN VIAGRA. OVER 12 MILLION PRESCRIPTIONS AND NOT ONE DEATH. WHAT IS DANGEROUS IS SEX. SOMEONE WHO HAS NOT EXERCISED IN TWO YEARS AND HE MAKES LOVE TO HIS WIFE AND HAS A HEART ATTACK, THAT IS THE EXERCISE.
SO IF YOU RAN AFTER A BUS, SO WE HAVE BECOME CONCERNED WITH HEALTH ISSUES. WE ASK THE PATIENTS WITH SERIOUS CARDIAC PROBLEMS, WHAT IS YOUR EXERCISE TOLERANCE? THERE IS NO CONTROVERSY AROUND VIAGRA OTHER THAN AVOIDING NIGHT RO GLIS RENN.

Mary says LET'S REMIND OUR VIEWERS, WE ARE TALKING TODAY ABOUT YOUR SEXUAL HEALTH, SEXUAL DYSFUNCTION. IF YOU HAVE ANY QUESTIONS, MALE, FEMALE, GIVE US A CALL.

The phone numbers and email reappear briefly.

Mary says WE HAVE A COUPLE ON THE LINE. MIKE AND MADELINE. HI. HOW ARE YOU?

The Caller says HI, MARY. HI, DOCTOR. WE ARE CURIOUS, I'M 65, MY HUSBAND IS 72. WE BOTH TAKE THIS WONDERFUL MEDICATION, TONS OF IT, FOR HIGH BLOOD PRESSURE. YOU KNOW THE RESULTS OF THAT? NO ERECTION, NO SEX. WHAT CAN BE DONE? ANYTHING?

Richard says HAVE YOU TALKED TO YOUR FAMILY DOCTOR ABOUT THE PROBLEM?

The Caller says THEY THINK WE SHOULD BE MORE CONCERNED ABOUT OUR HIGH BLOOD PRESSURE. IN MY CASE ALSO ANGINA AND FORGET ABOUT SEX.

Richard says WELL I CAN'T IMAGINE THAT YOUR DOCTOR WOULD SAY THAT BUT IF HE HAS, IF YOU ARE HELL ANY... HEALTHY ENOUGH TO DO ACTIVITIES, THERE ARE TREATMENTS YOU CAN HAVE WITHOUT GOING OFF THE BLOOD PRESSURE MEDICATION. I WOULD GO BACK AND ASK TO SPEAK ABOUT VIAGRA. CHANGING THE BLOOD PRESSURE MEDICATIONS DOESN'T MAKE A DIFFERENCE. SO IF YOU ARE HEALTHY, VIAGRA WOULD BE GOOD.

Mary says SO YOU HAVE PATIENTS WHO ARE ON BLOOD PRESSURE MEDICATION WHO ARE ALSO ON VIAGRA?

Richard says MOST PATIENTS ARE. THE SAME CONDITIONS THAT PRODUCE HEART DISEASE PRODUCE ERECTILE DYSFUNCTION. MANY PEOPLE WITH BYPASS SURGERIES HAVE DIFFICULTIES WITH ERECTION. ALL OF THEM WOULD BENEFIT FROM VIAGRA. YOU DON'T HAVE TO CHANGE MEDICATIONS. ITS SAFE TO DO THAT.

Mary says WHAT ABOUT AS FAR AS OTHER THINGS YOU CAN DO IN YOUR LIFE, SUCH AS EXERCISE, DIET; HOW DO THOSE COME INTO PLAY?

Richard says SMOKING IS A BIG ISSUE BUT MOST MEN CONTINUE TO SMOKE AND GIVE UP SEX. WE CAN'T CHANGE THAT. LIFESTYLE ISSUES ARE IMPORTANT. WE HAVE NOT BEEN SUCCESSFUL IN GETTING PATIENTS TO GET IN SHAPE TO GET THEIR SEX LIFE BACK. BUT THOSE WHO ARE CONCERNED IF YOU HAVE A LOW FAT DIET AND EXERCISE YOU'LL MAINTAIN A HEALTHY SEX LIFE LONGER.

Mary says ARE THERE VITAMINS OR NUTRIENTS THAT YOU CAN TAKE TO ENCOURAGE...

Richard says NO. BUT THERE ARE COMPANIES THAT ARE ON THE VIAGRA BAND WAGON SELLING NATURAL PRODUCTS. THE PROBLEM WITH SEX IS THERE IS A HIGH PLACEBO RESPONSE RATE IN STUDIES. SO IF YOU GIVE A MAN VITAMIN E AND TELL HIM ITS BEST, 30 PERCENT HAVE A RESPONSE BECAUSE THEY WANT TO GET BETTER. A LOT OF THE VITAMINS THAT ARE PURPORTED TO PRODUCE IMPROVEMENT PROBABLY DON'T.

Mary says SO WOULD YOU SAY THAT IS THE WAY APHRODISIACS WORK?

Richard says I THINK SO.

Mary says DO YOU PUT ANY IMPORTANCE ON APHRODISIACS?

Richard says THERE IS NO CLINICAL EVIDENCE THAT ANYTHING THAT WOULD PRODUCE AN INCREASE IN SEX DRIVE OTHER THAN HORMONES. ALL THE REPORTS ARE ANECDOTAL. IF I GAVE YOU SOMETHING AND SAID IT WILL IMPROVE YOUR SEX LIFE, ITS GOING TO STIMULATE YOU TO THINK ABOUT IT. MAYBE THAT IS ALL YOU NEED.

Mary says IS THIS A STRETCH? I HAVE HEARD WITH OYSTERS THEY ARE LOADED WITH ZINC AND THAT ZINC IS A VERY IMPORTANT PART OF MALE SEXUAL FUNCTION SO IF A MAN IS LOW ON ZINC, THE OYSTERS WOULD HELP BRING I'M UP TO PAR?

[LAUGHTER]

Richard says THAT IS A STRETCH. REAL STEVP. THEN HE WILL SMELL LIKE FISH.

[LAUGHTER]

Mary says LET'S TAKE ANOTHER CALL. DOUG IS ON THE LINE FROM TORONTO. HI.

The Caller says HI. I WAS WONDERING ABOUT A PROBLEM I BEEN HAVING. I WENT TO SEE A DOCTOR ABOUT A IF I HAD A BLADDER INFECTION. I HAD A URINE TEST AND SWAB TEST THAT TURNED OUT NEGATIVE. SO I WAS WONDERING WHAT ELSE IT COULD BE. I GOT MIGHT HAVE TO DO WITH A LUMP IN MY PENIS. I WAS WONDERING WHAT YOU WOULD DO ABOUT A LUMP.

Richard says THAT IS A LOT OF QUESTIONS. WHEN YOU GET AN E RECOGNIZE SHUN, IS THE PENIS STRAIGHT OR CROOKED?

The Caller says STRAIGHT.

Richard says WELL LUMPS IN THE PENIS MOST ARE TIME ARE NOTHING. DID YOUR DOCTOR EXAMINE YOU?

The Caller says YES.

Richard says I WOULDN'T BE CONCERNED BUT IF IT PERSISTS, GO BACK AND SEE HIM. AS FOR THE BLADDER INFECTION, A LOT OF MEN HAVE IRRITATION. IF THE CULTURES WERE NEGATIVE AND THE DOCTOR EXAMINED YOU, I WOULDN'T BE CONCERNED. ARE YOU CONCERNED YOU MAY HAVE HAD SEXUAL CONTACT THAT WAS NOT APPROPRIATE?

The Caller says NO.

Richard says TRANSIENT BLADDER IRRITATION IS NOT UNUSUAL.

Mary says YOU WERE SAYING THE LUMP IN A PENIS, IF IT DOESN'T KRAUZ A PROBLEM, DON'T RORRY... WORRY?

Richard says GENERALLY NOT. YOU HAVE TO FOLLOW IT TO MAKE SURE IT DOESN'T INCREASE IN SIZE. DISEASE OF THE PENIS IS CHARACTERIZED BY A LUMP THAT IS SOMETIMES PAINFUL AND THAT IS COMMON. SO ITS USUALLY NOTHING TO WORRY ABOUT. CANCER OF THE PENIS IS A CONDITION OF THE SKIN AND YOU CAN SEE CHANGES IN THE SKIN.

Mary says SO THIS DISEASE...

Richard says ITS VERY COMMON. WE DON'T KNOW WHAT CAUSES IT. I SEE FIVE OR SIX GUYS A WEEK WITH THE PROBLEM. ALL THEY NEED IS REASSURANCE THEIR PENIS IS CROOKED BUT DON'T WORRY. 30 PERCENT OF THE TIME ET GETS BETTER. SOMETIMES IT GETS SO CROOKED THEY CAN'T HAVE SEX AND WE DO SURGERY TO STRAIGHTEN IT OUT. A THIRD OF THE GUYS GET A BEND AND THEY LIVE WITH IT.

Mary says SO THERE IS NOTHING YOU CAN DO UNLESS ITS SURGERY?

Richard says NO MEDICATIONS HAVE SHOWN TO WORK. THERE MAY BE DEVELOPING SOMETHING YOU CAN INJECT IN THE LUMP TO SOFTEN THE SCAR TISSUE. WE THINK ITS RELATED TO TRAUMA OF INTERCOURSE AND LEAKAGE OF BLOOD OUTSIDE THE PE NEWS. THE IMMUNE REACTION TO THE BLOOD AN CAR SCARRING BUT WE ARE NOT CERTAIN. ITS SOMETHING GUYS WILL NOT TALK ABOUT WITH OTHER GUYS, FOR SURE.

Mary says NO. I'M ALSO WONDERING WHAT POINT DO MEN COME TO SEE YOU? IS IT LADIES AND GENTLEMEN IN THE STATE?

Richard says IT USED TO BE THREE YEARS THEY WOULD WAIT WITH SEXUAL DIFFICULTIES. OTHER PROBLEMS THEY COME IN BUT THEY ARE DRAGGED IN WITH BY THE PARTNER. NOW ITS PROBABLY 18 MONTHS WITH SEXUAL DIFFICULTIES. WE DON'T WANT TO SEE THEM AFTER THEIR FIRST SEXUAL DIFFICULTY BECAUSE IT MAY BE ANXIETY. SICK MONTHS IS A GOOD TIME. IF IT IS STILL A PROBLEM, GO SEE YOUR DOCTOR.

Mary says LET'S TAKE ANOTHER CALL. MARY FROM OTTAWA. HI.

The Caller says HELLO. THE PROBLEM THAT I WANT TO HEAR INFORMATION ABOUT IS TAKING ANTIDEPRESSANTS AND HAVING A LOWER SEX DRIVE. MYSELF AND OTHERS HAVE FOUND THERE IS A LACK OF INTEREST IN SEX.

Richard says SURE. THAT IS VERY, VERY, VERY COMMON. ANTIDEPRESSANTS ARE ONE OF THE LARGEST CAUSES OF SEXUAL DYSFUNCTION. IN MEN, IT SLOWS DOWN YOUR ABILITY TO EJACULATE. MANY COMPLAIN NOT ONLY IS THEIR LIBIDO LOW BUT THEY HAVE TROUBLE WITH E JACK RATING. DEPRESSION REDUCES LIBIDO. CERTAINLY. IT OFTEN WHAT YOU CAN DO IS ASK YOUR DOCTOR AND CHANGE... THERE ARE. DIFFERENT ANTIDEPRESSANTS THAT HAVE A LOWER INCIDENCE OF SEXUAL SIDE EFFECTS. IF YOU CHANGE TO ANOTHER, OFTEN YOU WILL BE BETTER. DON'T GO OFF IT THOUGH.

Mary says WOULD IT HAVE ANYTHING TO DO WITH THE CLASS?

Richard says YES. SSRI'S TRADITIONALLY CAUSE... PROZAC, ZOLOFT, NOT EVERYBODY. IN TEN PERCENT THEY WILL HAVE SIGNIFICANT PROBLEMS AND NEED TO CHANGE THE MEDICATION. JUST BECAUSE PACKS ILL ENTIRE FEAR WS YOUR SEX LIFE, DOESN'T MEAN PROZAC WILL. EACH PERSON REACTS DIFFERENTLY. SO YOU CAN TRY A NUMBER OF DIFFERENT ONES. ITS A REAL PROBLEM.

Mary says LET'S TAKE ANOTHER CALL. SANDRA, HI.

The Caller says HI. MY HUSBAND IS 52. I AM 48. HE'S BEEN HAVING DIFFICULTIES FOR BETWEEN FIVE AND SIX YEARS. THE FIRST... AFTER A COUPLE YEARS WE SAW A GP AND HE TESTED HIM FOR ANYTHING PHYSICAL. DIDN'T FIND ANYTHING. WE TRIED VIAGRA AND THAT DIDN'T SORT OF MAKE ANY DIFFERENCE. FROM THERE WE WENT TO SEE A COUPLE SEXUAL COUNSELOR FOR A YEAR IN HAMILTON. AFTER A YEAR, HE SAID NOTHING IS WRONG. EVERYTHING SHOULD BE FINE. BUT THERE WASN'T ANY CHANGE. AFTER THAT, MY HUSBAND STARTED GOING TO SEE A SY PSYCHIATRIST TO SEE IF THAT MIGHT BE WHAT WAS CAUSING IT. HE WENT THERE FOR ABOUT A YEAR. THEY DID SOME WORK WITH ANGER MANAGEMENT AND THAT STUFF. AT THE END OF JUST A LITTLE OVER A YEAR, HE SAID, YOU KNOW, THERE IS NOTHING WRONG. EVERYTHING SHOULD BE FINE. IT'S STILL NOT.

Richard says WHAT DO YOU THINK IS WRONG?

The Caller says I HAVE NO IDEA.

Richard says WHAT IS YOUR BEST GUESS?

The Caller says HE IS NOT INTERESTED.

Richard says WELL, IT'S DIFFICULT. WE CAN'T MAKE A DYING KNOW SITS BUT THIS IS A COMMON PROBLEM WE SEE PATIENTS WHO DON'T HAVE ANY OVERT PHYSICAL PROBLEMS AND ARE TOLD THERE IS NOTHING WRONG, EVERYTHING SHOULD BE FINE. THERE IS WHERE SEXUAL THERAPISTS, NOT PSYCHIATRISTS... THEY ARE NOT GOOD IN SEXUAL DYSFUNCTION BECAUSE THEY ARE USED TO TREATING PEOPLE WHO ARE MENTALLY ILL. SEXUAL DYSFUNCTION IS NOT A MENTAL ILLNESS. IT MAY BE A SIGN OF RELATIONSHIP PROBLEMS.

Mary says WHAT PERCENT OF PATIENT IS THIS WHERE EVERYTHING CHECKS OUT FINE.

Richard says A THIRD. VIAGRA DOESN'T WORK WELL IF ITS PSYCHOLOGICAL. VIAGRA DOES NOTHING FOR NORMAL ERECTIONS. A COUPLE LIKE THIS MIGHT BENEFIT FROM SEEING A SEX THERAPIST, NOT FOCUSING THAT ITS HIS PROBLEM, FOCUSING THAT ITS THEIR PROBLEM TO WORK ON TOGETHER. MAYBE GET AWAY FROM WORRYING ABOUT PENETRATION AS THE ONLY FORM OF SEXUAL COMMUNICATION. THERE ARE LOTS OF THINGS YOU CAN DO. MEN DRAW AWAY. IF TLAI CAN'T GET AN E RECOGNIZE SHUN, THEY DON'T CUDDLE OR ANYTHING. A THERAPIST WILL REESTABLISH THAT COMMUNICATION. MAYBE THE ERECTION WILL COME, MAYBE IT WON'T. A HARD PENIS IS OVER RATED. MANY WOMEN SAY ITS NOT THAT NECESSARY. INTERCOURSE IS IMPORTANT BUT NOT AS IMPORTANT AS MANY THINK IT IS.

Mary says WHAT ABOUT SIZE? MANY MEN THINK SIZE IS IMPORTANT.

Richard says WE ALL HAVE THE SAME SIZE PEN IS. ITS A MYTH. EVERY MAN HAS THE EXACT SAME SIZE PEN IS. THAT'S WHAT I TELL THEM. [LAUGHTER] IN EXTREME CASES IF YOU HAVE A VERY, VERY SMALL PENIS... BUT IF A MAN SAYS MY WIFE THINKS MY PENIS IS TOO SMALL, THAT IS A RELATIONSHIP ISSUE.

Mary says LET'S GO TO SAM NOW IN TORONTO.

The Caller says HI. I HAVE A QUESTION ABOUT THE SURGERY IF I WANT TO INCREASE INCHES. HOW MUCH IT COSTS?

Richard says YOU WANT TO INCREASE THE SIZE OF YOUR PENIS? DON'T, SAM. YOU'LL STILL BE UNHAPPY AFTER YOU ADD A CENTIMETER OR TWO. IT COSTS 3,000 dollars A CENTIMETER. I WOULD NEVER DO THE SURGERY. MOST YOUR OL JISTS WON'T TOUCH THE SURGERY BECAUSE THE TYPE OF PATIENT WHO SAYS MY PENIS IS NOT TOO BAD, THEY NEED A SY PSYCHIATRIST. INCREASING YOUR SIZE DOESN'T ILL PROVE SEXUAL SATISFACTION. IT DOESN'T IMPROVE THE PATIENT'S SELF WORTH. MOST THESE PATIENTS HAVE SERIOUS PSYCHOLOGICAL ISSUES. ASKING SOMEBODY, A LOT OF PATIENTS ARE VERY UNHAPPY AFTER THE SURGERY.

Mary says HAVE YOU MEAT THEM?

Richard says A LOT. THERE IS A VERY GOOD SURGEON IN TORONTO WHO DOES IT IN SELECTED CASES. THEY SEEM TO BE HAPPY BUT A LOT ARE NO HAPPIER. THERE ARE ALSO COMPLICATIONS FRS THE SURGERY. STAY AWAY FROM THAT.

Mary says HOW WOULD THAT BE DIFFERENT FROM WOMEN WHO ENLARGE THEIR BREASTS?

Richard says WHY DO WOMEN WANT TO ENLARGE THEIR BREASTS? FOR MEN OR FOR CLOTHES? I THINK MOST WOMEN EDGE LARGE THE BREASTS FOR THEMSELVES. IF YOU ASK THEIR HUSBANDS, THEY SAY, LEAVE IT ALONE, ITS FINE. MEN GO TO GET THEIR PENIS ENLARGED AN ITS NOT VISIBLE THROUGH THEIR CLOTHES. THEY THINK ITS GOING TO IMPROVE THEIR FUNCTION. I THINK ITS A DIFFERENCE. YOU CAN BLEND THE TWO BUT I THINK MOST WOMEN GET THEIR BREAST E ENLARGED SO THEY LOOK BETTER IN CLOTHES. MOST MEN THINK THEY WOULD LOOK MORE ATTRACTIVE AND ITS NOT THE CASE.

Mary says I AM NOT SO SURE ABOUT THE WOMEN'S REASON.

Richard says I'M NOT EER THEY ARE. I'M A MAN.

[LAUGHTER]

Mary says MARY?

The Caller says HI.
I'M WONDERING WHY WOULD ONE HAVE BURNING AFTER INTERCOURSE?

Richard says ITS PART OF THE WAY WOMEN ARE DESIGNED. ITS ALL VERY CLOSE TO THE PENIS WHEN IT GOES IN SO ITS A FRICTION PROBLEM. LOTS OF WOMEN HAVE BLADDER INFECTIONS AFTER INTERCOURSE BECAUSE BACTERIA GETS INTO THE BLADDER. WHAT WE ADVISE IS AFTER INTERCOURSE, VOID, EMPTY YOUR BLADDER. THAT WILL REDUCE INFECTION. BURNING MAY BE DRYNESS. DO YOU LUBRICATE?

The Caller says I'M NOT DRY.

Richard says IT MAY BE MORE OF A MECHANICAL PROBLEM. NOT THE SIGN OF ANYTHING SERIOUS. IF THE BURNING GOES AWAY IN A FEW HOURS, IT COMES WITH THE TERRITORY.

Mary says WOULD IT BE COMMON FOR WOMEN AFTER CHILDBIRTH TO BE MORE PRONE TO BLADDER INFECTIONS?

Richard says NOT REALLY. IF THEY SEVERE PRO LAPSE, THE BLADDER HAS FALLEN OR THEY HAVE OTHER VAGINAL PROBLEMS, IT MAY. MOST OF THE ISSUES WITH INFECTIONS ARE DUE TO FREQUENCY OF SEXUAL ACTIVITY, TAKING ANTIBIOTICS, CHANGING THE BACTERIA IN YOUR VA GINA. AROUND MENOPAUSE, YOU HAVE A DIFFERENT BACTERIA THEN. BUT ITS USUALLY NOT HYGIENE RELATED. WOMEN WHO THINK THEY GET INFECTIONS BECAUSE THEY ARE NOT CLEAN ENOUGH, ITS NOT THAT.

Mary says WHAT DO YOU THINK OF DO YOU REMEMBERING?

Richard says NOT MUSH. I DON'T THINK MANY WOMEN D O UCHE ANYMORE. WHEN I WAS YOUNGER IT WAS MORE COMMON. MOST WOMEN DON'T. IF YOU HAVE PROBLEMS WITH INFECTIONS AFTER SURGERY, THERE MAY BE A REASON FOR THAT. I DON'T THINK ITS NECESSARY.

Mary says SO YOU OWN SYSTEM CLEANS ITS WELL.

Richard says YES.

Mary says OKAY. LET'S GO TO RON. HI.

The Caller says YES, I STIMTS AFTER INTERCOURSE NOTICE THAT THE SKIN NEAR THE HEAD OF MY PENIS IS PULLED BACK. SOMETIMES IT FEELS LIKE A CUT AT THED OF THE PENIS.

Richard says HOW OLD ARE YOU?

The Caller says ALMOST 40.

Richard says ARE YOU CIRCUMCISED?

The Caller says YES.

Richard says SO THE SKIN AROUND THE HEAD OF THE PENIS GETS IRRITATED.

The Caller says YES. SOMETIMES ITS PULLED BACK AND IT CAN HURT SOMETIMES. I PUT CREAM ON IT.

Richard says THAT IS A COMMON OCCURRENCE IN MEN AS WE GET OLDER BECAUSE THE SKIN IS FRAGILE. DURING THE FRICTION OF INTERCOURSE, IT CAN BE IRRITATED. IF YOU USE A LOT OF STEROID CREAMS, IT THINS THE SKIN OUT. THE WAY TO PREVENT IT IS GOOD HYGIENE, MAKE SURE YOUR PARTNER IS WELL LUBRICATED. OTHER SKIN CONDITIONS CAN BE STREETED BY REMOVING THE SKIN THAT IS BREAKING DOWN.

Mary says YOU ASKED IF HE WAS CIRCUMCISED?

Richard says UNCIRCUMCISED MEN HAS A DIE CEASE WHERE WOMEN'S VAGINA'S GET DRY. WE SEE THAT IN MEN. ITS NOT OTHER REASON TO GET THE KIR COUPLE ZIGS AT BIT THOUGH.

Mary says I HAVE AN E-MAIL FROM ANDY. HE SAYS...

Mary reads from a laptop and says I WOULD BET A LOT OF PEOPLE WOULD LIKE TO HAVE THIS PROBLEM BUT IS THERE ANY WAY TO PREVENT AN E RECOGNIZE SHUN AT NIGHT? I HAVE ERECTIONS THAT LAST FOUR HOURS AND THERE IS NO SEXUAL DESIRE OR FEELINGS BUT IT ENTIRE FEARS WITH GETTING SLEEP. THIS IS A CONSTANT ISSUE, NOT JUST ONCE IN A WHILE.

Richard says I DON'T THINK MANY PEOPLE WOULD WANT THAT PROBLEM. MOST MEN HAVE ERECTIONS DURING THE NIGHT, THREE OR FOUR THAT MAY LAST AN HOUR. ITS WHEN IT BECOMES PROLONGED AND PAINFUL ITS AN ISSUE. THERE IS AN EXTREMELY RARE CONDITION AND I WOULD LIKE TO KNOW WHAT RACE HE IS, ITS MORE COMMON IN BLACK CANADIANS BECAUSE OF SICKLE CELL. THAT IS AN ISSUE IN THESE PATIENTS. THERE IS LITTLE THAT CAN BE DONE ABOUT THAT. SHE SHOULD BE EXAMINED TO MAKE SURE HE DOESN'T HAVE CANCER. YOU KNOW, MAYBE HE IS SLEEPING LIGHT AND PERCEIVES HE IS HAVING THE ERECTION ALL THE TIME. MY GUESS IS IF WE LOOKED AT HIS PENIS BUT PUTTING DEVICES ON IT HE DOESN'T HAVE AN E RECOGNIZE SHUN ALL NIGHT. BUT MOST MEN HAVE AN E erection.

Mary says WHY?

Richard says WE THINK ITS THE PENIS IN TRAINING. IT NEEDS BLOOD TO STAY HEALTHY. ITS PART OF THE WAY THE BODY KEEPS THE PENIS HEALTHY, GIVING IT A WORKOUT.

Mary says PENIS IN TRAINING. THAT IS A NOVEL PHRASE.

Richard says IF YOU DON'T USE IT, YOU LOSE IT. WE SEE IT IN OLDER MEN WHO, SAY AFTER THEIR WIFE DIES AND HE THEN THEY GET BACK TO DATER, THEY HAVE DIFFICULTIES. WE THINK THERE MAY BE A ROLE IN RIG STIMULATION OF THE PENIS. WE HAVE BEEN TRYING TO CONVINCE WOMEN OF THIS FOR YEARS. IT MAY BE THE WAY THE BODY KEEPS THE PENIS HEALTHY.

Mary says IS THIS RELATE TOD AGE?

Richard says WE DON'T WAKE UP WITH ERECTIONS AS MUCH WHEN WE ARE OLDER. MEN ARE CONCERNED. THEY SAY MY ERECTIONS ARE GONE. AS LONG AS YOU CAN GET IT WHEN YOU NEED IT, ITS NOT A PROBLEM.

Mary says I WANT TO TALK ABOUT MALE MENOPAUSE. IS THIS A REAL THING THAT HAPPENS WITH MEN?

Richard says I'M NOT SURE. ITS STILL CONTROVERSIAL. I DON'T LIKE TO CALL IT ANDROPAUSE. IF IT EXISTS IT DOESN'T HAPPEN TO ALL MEN. ITS A REDUCTION IN HORMONES THAT PRODUCES SYMPTOMS LIKE MENOPAUSE.

Mary says WHAT KIND OF SYMPTOMS.

Richard says HERE IS THE PROBLEM, A 50-YEAR-OLD MAN, INCREASE IRRITABLE, DECREASED ABILITY TO CONCENTRATE, REDUCED LIBIDO, INARM TO PERFORM SPORTS, FALL ASLEEP AFTER DINNER. MILD DEPRESSION. THAT DOESN'T SOUND LIKE ANDROPAUSE, IT SOUNDS LIKE MOST MEN OVER 50. SOME IS RELATE TOD HORMONES. AS MEN GET OLDER OUR HORMONE LEVELS DECREASE. SOME MEN DECREASE QUICKER THAN OTHERS. IDENTIFYING THOSE MEN WITH LOW TESTOSTERONE AND THE SIM POMS THAT BRINGS THEM PERSONAL DISTRESS IS THE CHALLENGE. I THINK IT EXISTS. I THINK ITS A SMALLER GROUP OF MEN THAN THE PHARMACEUTICAL COMPANIES LEAD YOU TO BELIEVE.

Mary says SO YOU ARE SAYING IT COULD BE A NATURAL PROCESS FOR MANY MEN? ITS JUST A SMALL SEGMENT THAT HAVE THE SEVERE SYMPTOMS.

Richard says ITS EXAGGERATED AGING. IF YOU GET THE SYMPTOMS YOU EXPECT TO GET IN YOUR 70s IN YOUR 30s, THERE MAY BE A NEED FOR TREATMENT. TREATING THE MEN MAY IMPROVE YOUR HEART FUNCTION. IF IT IMPROVES YOUR LIBIDO, IT MAY IMPROVE YOUR RELATIONSHIP.

Mary says BECAUSE THIS IS NOW BEEN GIVEN A NAME, MEN HEAR OH, THIS IS AWAY TO TREAT THIS, YOU CAN HAVE TESTOSTERONE, ARE MEN CRYING FOR IT?

Richard says THEY ARE ASKING FOR IT. WHEN YOU DISCUSS IT WITH THEM AND CHECK THEIR TESTOSTERONE, YOU REALIZE ITS TEENAGERS. AT 50 YEARS OLD, YOU HAVE TEEN AGERS AT HOME, YOU ARE WORKING, TIRED. THE ANSWER MAY NOT BE TESTOSTERONE. IT MAY BE LIFESTYLE MANAGEMENT. WE DO THAT FIRST. LOOK AT EXERCISE. ARE THEY SMOKING? OVERWEIGHT? AFTER ALL THAT IS DEALT WITH, IF THEY ARE STILL HAVING DIFFICULTIES, THERE IS A ROLE FOR TEST TESTER ROAN REPLACEMENT?

Mary says IS THERE A ROLE FOR TESTOSTERONE FOR WOMEN?

Richard says ITS IMPORTANT. WE DO FIND IN SOME WOMEN WHO ARE OTHERWISE HEALTHY, HAVE NO PROBLEMS, THAT BY SUPPLEMENTING THEM WITH SOME OR AL TEST TOS TER REASONS, WE CAN IMPROVE THEIR LIBIDO AND THEY WON'T GROW A BEARD. IT CAN BE HELPFUL.

Mary says LET'S TAKE ANOTHER CALL. SARA ON THE LINE. HI.

The Caller says HI. MY QUESTION IS CONCERNING PROSTATE CANCER. MY HUSBAND ST. 39 AND HE HAS FOR A COUPLE YEARS BEEN HAVING TROUBLE URINATING. IT TAKES HIM A LONG TIME TO GO TO THE WASH ROOM. I WAS WONDERING WHAT SIGNS THERE ARE FOR PROSTATE CANCER?

Richard says MOST OF THE TIME THERE ARE NO SIGNS. AT 39... DOES HE HAVE A BROTHER OR A DAD WITH PROSTATE CANCER?

The Caller says NO.

Richard says AT 39 YEARS OF AGE, ITS UNAUSHL. THE COMMONEST THING THAT WOULD PRODUCE THE VOIDING PROBLEMS WOULD BE SCAR TISSUE ALONG THE PASSAGE WAY OR POSSIBLY PROSTATE ENLARGEMENT. BUT THAT IS RARE IN 39.

Mary says WHEN ARE WE LIKELY TO SEE THAT?

Richard says 50. THE SIGNS FOR PROSTATE CANCER? THERE ARE NO SIGNS. 80 PERCENT OF PATIENTS DISCOVER THEIR PROSTATE CANCER THROUGH A PSA TEST AND A RECTAL EXAMINATION.

Mary says WITH A PSA TESTS, THERE HAS BEEN CONTROVERSY OVER THAT. HOW EFFECTIVE IS IT.

Richard says VERY. I'M NOT SURE WHERE THE CONTROVERSY IS. THE PROBLEM IS ITS NOT A GOOD TEST TO SCREEN ALL YOUR MEN FOR PROS KATE CANCER WITHOUT TALKING TO THEM, EXAMINING THEM, FOLLOWING THEM ALONG. IF YOU USE IT THAT WAY WHERE YOU PICK YOUR PATIENTS THAT ARE 50 OR OLDER, DO A RECTAL EXAMINATION, DO A YEARLY PSA, YOU'LL IDENTIFY CANCER MUCH, MUCH EARLIER. THE CONTROVERSY IS DO YOU USE IT IN A 39-YEAR-OLD MAN? PROBABLY NOT. IN AN 85-YEAR-OLD MAN WHO YOU ARE NOT GOING TO TREAT? PROBABLY NOT. BUT ITS A GOOD TOOL.

Mary says OKAY. WHAT ABOUT PROSTATE HEALTH? WE READ SO MANY THINGS ABOUT DIET, VITAMINS FOR GOOD PROS KATE HEALTH. ARE THERE THINGS THAT WE CAN DO?

Richard says THERE ARE. GOOSE GOOD EVIDENCE IN THE LITERATURE IF YOU TAKE... MEN WHO LIVE IN AREAS WHERE PROSTATE CANCER IS VERY LOW, TAKE A JAPANESE MAN AND MOVE HIM TO HAWAII, THEN U.S.A., HIS RISK OF CANCER GOES UP WITH THE CHANGE IN DIET. WE KNOW A DIET RICH IN ANIMAL FATS IS BAD. A DIET THAT IS HIGH INVITE MIN E IS GOOD. MICROPEENS, FOUND IN TOMATOES. BUT WE A EXPERT WHO LOOKED AT THIS AND YOU DON'T NEED TO TAKE SUPPLEMENTS. THE INDUSTRY THAT SELLS THE SUPPLEMENTS MAY LEAD YOU TO BELIEVE YOU TAKE TO TAKE VITAMIN E BUT MOST CAN BE FOUND IN A REGULAR DIET.

Mary says WHAT ABOUT SOLPAUL MET TOE?

Richard says THOO IS A POPULAR TREATMENT FOREIGN LARGED PROSTATE. NOTHING TO DO WITH CANCER.

Mary says WHAT IS IT?

Richard says ITS A HERB THAT IS SUPPOSED TO REDUCE TESTOSTERONE LEVELS IN THE PROSTATE. THERE IS ENOUGH EVIDENCE THAT A NUMBER OF US ARE LOOKING AT IT TO SEE IF IT WORKS. ITS VERY POPULAR IN EUROPE M WHEN MY PATIENTS SAY THEY HAVE IT, I ENCOURAGE THEM TO STAY ON IT. WON'T HURT.

Mary says LET'S TAKE A CALL FROM LIZ IN OWEN SOUND.

The Caller says HI. I'M NOT SURE IF THIS IS MORE FOR ME OR MY BABY. I HAD HIM CIRCUMCISED WHEN HE WAS BORN. THE DOCTOR DIDN'T WANT TO DO IT. I DON'T KNOW IT WAS DONE PROPERLY. IF YOU ARE CHANGING THE BABY, ON THE BOTTOM SIDE OF THE HEAD OF THE PENIS THERE IS A HUGE FLAP OF SKIN. FOR A WHILE, THERE WAS LIKE PUSS COMING OUT. MY QUESTION IS, IS IT GOING TO EFFECT HIM LATER? SHOULD I WORRY ABOUT HAVING IT SURGICALLY REMOVED BEFORE HE IS OLDER? YOU KNOW WHEN HE IS 17 AND HE GETS IT RIPPED OFF IN HIS ZIPPER AND THEY MAKE A MOVIE OR SOMETHING.

Richard says WHY DID YOU HAVE HIM CIRCUMCISED?

The Caller says FOR CLEANLINESS.

Richard says I THINK YOU ARE NEURO ROTIC STILL. HE PROBABLY HAD A SLIT. THE DOCTOR CUT THE SKIN AND LET IT FALL BACK, WHICH IS FINE. I DON'T BELIEVE THERE IS ANY REASON TO DO THE SURGERY. SO I'M BIASED. WHEN PAY CONTINUES COME TO ME AND THEY SAY I WANT YOU TO LOOK LIKE YOUR DAD. A LITTLE BOY DOESN'T WANT TO LOOK LIKE HIS DAD, EVER. THERE IS SKIN ON THE BOTTOM. HE WILL PROBABLY GROW INTO IT. THE PENIS CHANGES. MOST OF THE SKIN FOLDS IN. DON'T WORRY. HE WILL BE FINE.

Mary says SO THE LITERATURE AS FAR AS INFECTIONS LATER ON.

Richard says ITS POLITICAL. THERE ARE PEOPLE WHO ARE AGAINST IT, PEOPLE FOR IT. I THINK OUR EXPERIENCE GENERALLY IS THAT YOU DON'T NEED TO HAVE THE SURGERY. INFRUKT THEM HOW TO CLEAN. IF YOUR CHILD DOESN'T CLEAN BEHIND THE SKIN AT 13, HE HAS OTHER ISSUES.

Mary says LET'S TALK ABOUT INCONTINENCE. YOU WERE SAYING ITS COMMON IN WOMEN. WHAT WOULD BE THE MOST COMMON INCONTINENCE?

Richard says THERE IS URGE IS I GOT TO PEE, GOT TO GET THERE. ITS MORE COMMON IN WOMEN AND THEY NOWHERE EVERY BATHROOM IS EVERY PLACE THAT GO. THE OTHER END IS STRESS INCONTINENCE WHERE YOU LOSE WATER WHEN YOU COUGH OR SNEEZE. THE URGE INCONTINUE NUNS IS MUCH MORE COMMON. PROBABLY TEN TIMES MORE COMMON. ITS DUE TO OVER ACTIVE BLADDER. VERY MEDICAL TERM, ISN'T IT. ITS PROBABLY HORMONE FACTORS, HABIT FACTORS THAT GET YOUR BLADDER OVERACTING DOESN'T LIKE TO BE FULL. THERE ARE GOOD MEDICATIONS FOR THAT. WE ARE DOING TRIALS ON MEDICATIONS THAT ARE KNEW. ITS A A GROWING CONCERN BECAUSE OF THE COST OF THE OVER ACTIVE BLADDER. ELDERLY WOMEN WHO BECOME SHUT-IN HIS BECAUSE THEY CAN'T GO ANYWHERE WITHOUT RUSH TO GO THE BATHROOM. SO ITS A REAL PROBLEM. STRESS INCONTINENCE OCCURS MORE AFTER CHILDBIRTH OR IN WOMEN WHO ARE VERY HEAVY AND THEY LOSE PUSLE TONE IN THE PELVIS. THAT IS TREATED THROUGH BUY YOU FEEDBACK OR PELVIC EXERCISES WHICH ARE NOT SUCCESSFUL.

Mary says SO DON'T DO THEM?

Richard says DO THEM. WON'T HURT. PROBABLY WON'T MAKE A DIFFERENCE. LOSE WEIGHT IF YOU NEED TO DO SOMETHING ABOUT YOUR BLADDER. THERE ARE SOME NEW MEDICATIONS IN AGAINMENT THAT MAY TREAT IT. THERE ARE OPERATIONS. EVERY YEAR THERE IS A NEW OPERATION SO WHAT THAT TELLS ME IS NONE OF THEM WORK WELL. SO ITS A PROBLEM, STRESS INCONTINENCE. BUT THERE ARE GOOD PROCEDURES. IF IT CHANGES YOUR LIFE, GET IT TREATED.

Mary says I HAVE HEARD IT BEING COMMON AFTER CHILDBIRTH. IS IT SOMETHING THAT WOULD BE SELF CORRECTING WITH MANY WOMEN?

Richard says MOST WOMEN AFTER CHILDBIRTH GET BETTER SIX TO EIGHT MONTHS AFTERWARDS. ITS NATURAL THE BODY RELAXES THE PELVIC FLOOR TO ALLOW THE BABY COME OUT. TO IT TIGHTENS UP WITH TIME. THE EXERCISES ARE GOOD THEN. REGULAR EXERCISES AND LOSING ALL THE WEIGHT WILL HELP AS WELL.

Mary says I HAVE HEARD ABOUT KEGEL EXERCISES FOR MEN. IS THERE A PLACE FOR THOSE?

Richard says NOT REALLY. GIVES THEM SOMETHING TO DO WHILE WATCHING TELEVISION, I GUESS. ITS SOMETHING WE SUGGEST TO MEN AFTER THEIR PROSTATE GLAND IS REMOVED. BUT THERE IS NO DIFFERENCE IN THE IMPROVEMENT RATE. ITS ALSO THOUGHT TO IMPROVE CONTROL OF ejaculate AND THEY FOCUS ON THE EXERCISE. BUT MEN ARE FOCUSED ENOUGH ON THEIR PENIS.

[LAUGHTER]

Mary says YOU MENTION ABOUT RADICAL PROSTATE REMOVAL. THERE HAVE BEEN ADVANCEMENT IN SURGERIES. CAN YOU TALK ABOUT THAT?

Richard says THE BIG ADVANCE IS WE IDENTIFY PATIENTS EARLIER SO THAT THE ONE THING THAT PRODUCES BETTER SURGICAL RESULTS ARE BETTER PATIENT. GOOD, HEALTHY YOUNG PATIENT MAKE US LOOK GOOD. PLUS WE ARE DOING MORE OPERATIONS BECAUSE WE ARE FINDING MORE CAN SERIOUS. SO THE SURGEONS ARE MORE SKILLED, SO PRACTICE MAKES PERFECT. NOW WE ARE LOOKING AT DOING THEM WITH A LAP RO SCOPE, KEY HOLE SURGERY. THAT ALLOW IT IS PAY SHINT TO GET BACK TO WORK QUICKER. IT MAY MAKE THEM LESS LIKELY TO BECOME IMPOTENT.

Mary says IS THAT ONE OF THE BIG CONCERNS OF MEN WHO HAVE SURGERY?

Richard says NO. THE BIG CONCERN IS AM I GOING TO BE ALIVE NEXT YEAR? WE TALK ABOUT SEXUAL FUNCTION TO THEM AND THEIR PARTNERS. THEIR PARTNERS HAVE HAPPY TO HAVE THEM ALIVE AS WELL. ITS A CONCERN LATER ON AFTER THE SURGERY IS SUCCESSFUL. SO WE TALK ABOUT IT BEFORE THE SURGERY. WE GIVE THEM WAY TOS PRESERVE SEXUAL FUNCTION. BUT TO MOST MEN WITH CANCER, THEY JUST WANT TO BE ALIVE.

Mary says WHAT ABOUT THE SURGERY WITH RADIOACTIVE SEEDS?

Richard says ITS A NEW... ITS BEEN AROUND. ITS REINVENTED BECAUSE THEY HAVE NEW SEEDS. BECAUSE WE ARE FINING CANCER PATIENT EARLIER. THE THERAPY MAY BE AS GOOD AS SURGERY. I DON'T THINK IT IS. RIGHT NOW THEY CAN'T SUPPORT ITS AS GOOD AS SURGERY. THERE IS A TRIAL AT SUNNY BROOK HOSPITAL COMPARING THEM WHICH WILL ANSWER THAT QUESTION. IN SOME PATIENT WHO DON'T WANT SURGERY OR WHO ARE TOO OLD TO HAVE SURGERY, GENERALLY WE LIKE PATIENTS WITH A 10 YEARLY LIFE EXPECTANCY TO THINK ABOUT SURGERY. BECAUSE ITS TOUGH ON YOU.

Mary says OKAY. LET'S TAKE A CALL FROM BARBARA. HI.

The Caller says HELLO. I REALLY AM ENJOYING YOUR PROGRAMME. THIS IS EMBARRASSING BUT I HAVE A PROBLEM AND I AM HOPING YOU CAN DISCUSS IT. I AM A 50-YEAR-OLD WOMAN WITH A PAST HISTORY OF A HYSTERECTOMY. I HAVE A PRO LAPSED BLADDER AND ASSISTTO SEAL. THEY DON'T WANT TO DO SURGERY TO CORRECT THEM BUT I FIND I AM AVOIDING SEX AND BATHING VERSUS SHOWERING AND SWIMMING. I'M BEGINNING TO FEEL LIKE I SHOULD JOIN THE...

Richard says HAVE YOU TRIED HAVING SEX?

The Caller says I'M AFRAID TOO. EVERYTHING IS SO OPEN IN THERE. I'M WORRIED THERE MAY BE DAMAGE DONE.

Richard says LET'S TALK ABOUT THAT. YOU PROBABLY SHOULD TRY. MY GUESS IS ITS NOT GOING TO BE AS PAINFUL AS YOU THINK. THIS IS A COMMON PROBLEM. WHAT SHE DESCRIBED WAS HER BLADDER HAS FALLEN DOWN INTO THE VAGINA, THE BACK WALL OF THE VI NA HAS WEAKENED SO WHEN SHE LOOKS IN THE MIRROR, SHE SEES A BULGE, PROBABLY. AFTER YOU HAVE A HYSTERECTOMY, THE LIGAMENTS OF THE VA NI YEAH ARE CUT AND IT TURNS INSIDE OUT. MOST THE TIME IT DOESN'T INTERFERE WITH SEX THAT MUCH. ITS MORE OF A PERSONAL CONCERN.

Mary says SHE MENTIONED THREE THINGS SHE HAS HAD DONE.

Richard says THREE CONDITIONS SHE HAS. HAVE YOU HAD SURGERY?

The Caller says NO. THE FIRST GYNECOLOGIST RECOMMENDED SURGERY BUT I MOVED TO A DIFFERENT PROVINCE. I'M IN ONTARIO NOW. IT SEEMS THE GYNECOLOGISTS HERE DON'T RECOMMEND HAVING IT DONE.

Richard says I'M SURPRISED IF ITS CAUSING YOU PERSONAL DISTRESS.

Mary says EXPLAIN THE SEALS.

Richard says ITS THE TERM FOR A WEAKNESS OR A BULGE. THE RECTUM PUSHES INTO THE VAGINA SO YOU CAN SEE PART OF THE RUK TUM. A BULGE. THE OTHER SEAL IS WHEN THE BLADDER PUSHES INTO THE VAGINA. SO A BULGE IN THE BACK, ONE IN THE FRONT AND A PRO LAPSE FROM THE TOP. YOU CAN SEE A BULGE IN THE VAGINA WHEN A PERSON STANDS UP. GENERALLY THEY ARE NOT LIFE-THREATENING ISSUES. WHAT SHE IS PROBABLY GETTING FROM THE DOCTOR IS YOU DON'T NEED TO GET IT FIXED, LIVE WITH IT IF YOU CAN. SHE PROBABLY NEEDS TO SAY, LOOK, I DON'T WANT TO LIVE WITH IT. I'M CONCERNED ABOUT MY SEXUAL DYSFUNCTION. FIX IT. I WOULD HAVE SEX FIRST BEFORE I WORRY BECAUSE THESE OPERATIONS CAN FURTHER MAKE PROBLEMS. THEY MAY MAKE THE VAGINA SHORTER, SMALLER, TIGHTER. IF YOU HAVE AEG PART NER, IT WILL STRETCH WITH TIME. I WOULD SPEAK TO A DOCTOR. MAKE SURE THE MESSAGE IS GETTING THROUGH YOU ARE CONCERNED AND YOU WANT TO STAY SEXUALLY ACTIVE. GIVE IT A TEST RUN FIRST BEFORE SURGERY.

Mary says LET'S TAKE ANOTHER CALL. JOE.

The Caller says HELLO. TWO YEARS AGO I WAS IN THE HOSPITAL FOR THREE MONTHS FROM A BLADDER INFECTION. AFTER ALL THAT, THE DOCTOR TOLD ME I HAD A HYPO TONIC BLADDER. YESTERDAY I HAD TO GO TO THE EMERGENCY. THEY HAD TO PUT A CATHETER AGAIN. THEY SAID IT WAS A SWOLLEN PROSTATE. I DON'T KNOW WHAT THE HECK IS GOING ON.

Richard says NEITHER DO I. WHAT A HYPO TONIC BLADDER IS A BLADDER THAT HAS LOST THE NERVES AND DOESN'T SENSE WHEN ITS FULL. WE SEE THAT IN SOME DIABETIC MEN, MEN WITH SPINAL CORD INJURIES. A BIG PROSTATE WE ALL GET SO ITS HARD TO SORT THAT OUT. THERE ARE TESTS YOU CAN DO. YOU NEED TO SEE A UROLOGIST. HE WILL SORT IT UT. ITS NOT A COMMON PROBLEM. THE CATHETER THAT HE MENTIONED IS A TUBE THAT GOES IN TO BRAIN THE URINE AWAY.

Mary says YOU TALK ABOUT NEW DEVELOPMENTS IN SURGERY. NOTHING REALLY SEEMS TO BE WORKING. WOULD THERE BE CASES WHERE YOU SAY, YOU HAVE TO GET SURGERY? ITS THE LAST RESORT.

Richard says ITS NOT... WE WOULDN'T CALL IT THE LAST RESORT BECAUSE REARE SURGEONS. WHEN I STARTED PRACTICE 18 YEARS AGO, I WOULD DO TWO TO THREE HUNDRED OPERATION AS YEAR ON THE PROSTATE GLAND. NOW WITH GOOD MEDICAL THERAPY, I DO 10 OR 15. THERE ARE GOOD DRUGS AVAILABLE. THERE IS TRIALS THAT OPEN IT IS BLADDER BETTER. MOST MEN CAN BE TREATED MEDICALLY. ITS WHEN THEY HAVE COMPLICATIONS FROM THE MEDICAL THERAPY, SIDE EFFECTS, OR THE DRUGS DPIVE YOU HEADACHES, IF THE MEDICAL THERAPY IS NOT WORKING, WE RESORT TO SURGERY. IF THEY WANT SURGERY, MANY MEN DON'T WANT TO BE ON DRUGS FOR 10 YEARS. THE SURGERY WORKS WELL. WE GO UP THROUGH THE FOR NIS, ITS LIKE CORING AN APPLE. THEY HAVE A BETTER STREAM.

Mary says LET'S HEAR FROM THUNDER BAY.

The Caller says HI. WILL YOU RECOMMEND THE USE OF HERBAL SUPPLEMENTS OR POLGSS TO INCREASE SEXUAL FUNCTION? DOES SMOKING OR ALCOHOL EFFECT THE AMOUNT OF BLOOD THAT GOES INTO A MAN'S ERECTION.

Richard says WHATEVER WORKS, TAKE IT. SO LONG AS YOU BUY IT AS AT A DRUG STORE AND YOU KNOW WHAT IS IN IT. THERE IS NO SCIENCE BEHIND IT BUT THAT HAS NEVER STOPPED US FROM TRYING. SMOKING IS A LEADING CAUSE OF ERECTION PROBLEMS. SOME PEOPLE SAY THAT THE PENIS IS THE WINDOW TO THE HEART. IF A PATIENT COMES TO US HAVING ERECTION PROBLEMS, NOT GOODING BLOOD FLOW TO THE PENIS, WE CAN ASSUME THEY ARE HAVING THE SAME PROBLEM WITH THEIR HEART. WE LOOK AT CARDIAC FUNCTION, TALK TO THEM ABOUT CHANGING SMOKING HABITS. SMOKING IS A MAJOR CONCERN. MOST MEN DON'T CHANGE WHEN WE TELL THEM TO QUIT SMOKING. SO WE SAY IF YOU INSIST ON SMOKING, DON'T SMOKE AN HOUR BEFORE SEX. IT MAY HELP. BUT ITS BETTER TO QUIT. MOST MEN FIND IF THEY QUIT SMOKING THEY WILL GET BETTER. BUT I CAN'T GUARANTEE. BUT THEY WILL HAVE MORE MONEY TO PAY FOR THE DRUGS.

[LAUGHTER]

Mary says WHAT ABOUT ALCOHOL?

Richard says WE DON'T KNOW FOR SURE. A LOT OF ALCOHOL IS A DEPRESSANT. ITS NOT UNUSUAL FOR HEAR MEN SAYING I HAD DIFFICULTY... MET A GIRL LAST NIGHT... EIGHT DRINKS... SO ALCOHOL IN EXCESS IS A PROBLEM. CHRONIC USE OF ALCOHOL IS A PROBLEM BECAUSE IT EFFECTS YOUR TESTOSTERONE LEVELS. SO MEN THAT ARE CHRONIC HEAVY DRINKERS WHO DRINK FIVE OR SIX OUNCES A DAY, ITS NOT UNCOMMON, CAN HAVE PROBLEMS. THEY SAY, LOOK, I DON'T FEEL LIKE HAVING SEX. THAT IS WHEN THEY SHOULD LOOK AT THE ALCOHOL.

Mary says OKAY. JAMES IS ON THE LINE NOW. HI.

The Caller says HELLO. I HAVE A QUESTION FOR THE DOCTOR. IS IT THE HIGH BLOOD PRESSURE ITSELF OR THE MEDICATION FOR THE HIGH BLOOD PRESSURE THAT WOULD EFFECT THE ERECTION?

Richard says BOTH. I THINK ITS THE WAY THE BLOOD VESSELS ARE AND MAYBE THE MEDICATIONS AS WELL. UNFORTUNATELY WHEN THE PATIENT COMES WITH HIGH BLOOD PRESSURE, WE CHANGE THE MEDICATIONS, IT RARELY MAKES A DIFFERENCE. ITS ONLY WHEN THE PATIENT SAYS I WAS FINE UNTIL I STARTED THIS BETA BLOCKER OR WHATEVER, NOW I'M HAVING PROBLEMS DOES CHANGING THE MEDICATION MAKE A DIFFERENCE. WE THINK ITS THE STATE OF THE WHOLE SYSTEM THAT MAKES IT LESS RESPONSIVE. THE PENIS IS SIMPLE, MUCH LIKE THE MEN THAT CARRY IT. IT NEEDS TO OPEN UP AND STORE BLOOD. I'M NOT SURE ITS THE MEDICATION.

Mary says YOU KNOW, YOU ARE SAYING THE PENIS BEING A SIMPLE ORGAN. THE PROBLEMS USUALLY BEING PHYSIOLOGICAL FOR MEN. BUT COMPLICATED FOR WOMEN. THEY CAN BE.

Richard says MEN MAKE THE PROBLEM WORSE. WE HAVE A COUPLE FAILURES THEN ITS A A SPIRAL. WE ARE CONCERNED WE WON'T BE ABLE TO PERFORM SO WE GET AN SHOWS, THE BLOOD VESSELS STAY TIGHT. SO ITS A SELF FULFILLING PROPHECY. WHEN WE LOOK CLOSER AND WE UNDERSTAND FEMALE SEXUAL FUNCTIONS, THE SAME THINGS THAT EFFECT MEN, DIABETES, HEART disease, SMOKING, ARE INTERFERING WITH WOMEN. WE HAVEN'T BEEN ABLE TO SORT IT OUT YET BECAUSE IT'S DIFFICULT TO STUDY THE FEMALE RESPONSE IN A LAB. WE CAN TEST THE BLOOD FLOW IN THE PENIS. WE CAN INJECT THE PENIS WITH A DRUG AND MEASURE BLOOD FLOW. ITS MORE DIFFICULT IN WOMEN.

Mary says YEAH. BECAUSE THE PROBLEMS CAN BE COMPLICATED. YOU WERE SAYING THERE IS A BUSY SCHEDULE, CHILDREN, YOU ARE TIRED, ALL THESE THINGS THAT COME INTO IT, WHEN YOU HAVE COUPLES WHO COME IN, YOU HAVE TO GO BEHIND THE PHYSICAL PROBLEMS, DON'T YOU?

Richard says WELL I'M NOT SUITED TO DO WITH THAT. I HAVE LEARNED ON THE FLY TO IDENTIFY WHEN THERE ARE COUPLE ISSUES. WE HAVE A DOCTOR THAT WORKS WITH US TO HELP WITH THAT. THERE ARE GOOD SEX THERAPISTS THAT DEAL WITH IT. YOU NEED TO DEAL WITH COUPLE ISSUES FOR SURE. OFTEN I WILL LISTEN TO THE MAN TELL ME THE STORY, THE WIFE SAYING NO,. SO ITS GOOD TO HAVE BOTH PEOPLE THERE TO FINE OUT WHAT THE PROBLEM IS. BUT I CAN'T DEAL WITH COUPLE ISSUES. PART OF THE TIME ITS ALL YOU NEED TO DO IS TELL THEM HE IS OKAY, ITS A COMMON PROBLEM. I CAN GIVE YOU BACK ERECTIONS WITH LIFESTYLE CHANGES OR MEDICATION. YOU GUYS WORK IT OUT. THERE IS A LOT OF GULT. AFTERNOON THE PARTNER FEELS SHE IS NOT ATTRACTIVE ANYMORE. IF SHE HEARS IT, NO, ITS DIBEE TEST, SHE IS RELIEVED AND THEY CAN WORK IT OUT. SEX THERAPY IS EXPENSIVE TOO.

Mary says NOT COVERED?

Richard says NO. ITS WORTH THE PRICE THOUGH. THE COUPLES THAT GO, MONEY WELL SPENT.

Mary says PSA TESTS IS NOT COVERED EITHER?

Richard says NO.

Mary says DO YOU FEEL IT SHOULD BE?

Richard says DEFINITELY. SHOULD BE COVERED. THAT IS A POLITICAL ISSUE M I DON'T KNOW WHY ITS NOT COVERED. IF IT WAS A TEST THAT FOUND CANCER IN WOMEN, IT WOULD BE COVERED. WOMEN ARE MORE POLITICAL ACTIVE. MEN ARE GETTING BETTER. WE NEED TO BE MORE POLITICALLY ACTIVE AND LOBBY THE GOVERNMENT TO GET THE PSA TEST COVERED.

Mary says IS THAT SOMETHING THAT MEN SHOULD BE GOING IN TO THEIR DOCTORS AN ASKING ABOUT?

Richard says THEY SHOULD ASK ABOUT IT, NOT FOR IT THE FAMILY DOCTOR WILL DECIDE IF ITS APPROPRIATE.

Mary says THANKS SO MUCH FOR COMING IN. DR. RICHARD CASEY A UROLOGIST AND THE DIRECTOR OF THREE HEALTH CENTERS...

A slate reads "Fe/Male Health Centres Oakville. 905-338-3130; www.malehealth.com."

Mary says But that is it for today's show. Thanks for watching and please join me each weekday, Monday to Friday, for More to Life at 1 o'clock.

A slate reads "The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances."

Watch: Urology