Mo' Better Man

Movember, the month formerly known as November, is an annual, month-long charity event where Irish men grow a moustache to raise funds for Action Prostate Cancer - an initiative of the Irish Cancer Society.

Prostate Cancer is the most common male cancer amongst Irish men with figures predicted to rise ahead of Breast Cancer over the next decade with one in nine Irish men developing prostate cancer during the course of their lifetime.

Last year, Movember’s second in Ireland, 7,000 Irish Men donated their faces to the cause raising over €1 million. Men, or Mo Brothers as they are commonly referred to, are clean shaven at the beginning of the month and left free to groom and cultivate their upper lip shrubbery throughout Movember. The symbol of the moustache is said to be equivalent to that of the prominent pink breast cancer ribbon except with men wearing their ribbon on their face!

No one knows for sure how to prevent prostate cancer but diet and a healthy lifestyle may be important in protecting against the disease. Researchers believe a diet high in saturated animal fats and red meat may be responsible for the high incidence of prostate cancer in Western countries. It is thought that reducing your intake of animal fat and eating more fruit and vegetables may lower the risk of prostate cancer developing or spreading.

Interestingly a recent study of nearly 48,000 men found that Lycopene which is found in tomatoes, tomato products, red grapefruit and watermelons appears to reduce the risk of prostate cancer, supporting recommendations to increase consumption of fruit and vegetables, which are high in other antioxidants and bioflavonoid pigments that protect against various cancers.

Prostate Cancer can develop when cells in the prostate gland start to grow in an uncontrolled way. In most cases this is a slow growing cancer that men will be unaware of throughout their life because it may never cause any symptoms or problems. However, some men will have a fast growing cancer that needs treatment to prevent or delay it spreading outside the prostate gland. The prostate itself is around the shape and size of a walnut which lies beneath the bladder surrounding the tube that men pass urine and semen through.

The risk of being diagnosed with prostate cancer grows higher as you get older. Most men diagnosed with the condition are over 50 with the risk said also to increase if a close family member (father or brother) has prostate cancer.

One of the main problems associated with prostate cancer is that in its early stages, it often does not have any symptoms. When symptoms do occur, they may include any of the following:

• Having a need to rush to the toilet to pass urine.

• Difficulty in passing urine.

• Difficulty starting to pass urine or / and a weak or reduced urine flow.

• Starting and stopping whilst passing urine.

• Discomfort (pain or burning) while passing urine.

• A feeling of not having emptied the bladder fully.

• Dribbling of urine or semen

• Pain or stiffness in the back, hips or pelvis.

Less common symptoms include:

• Pain when passing urine

• Pain when ejaculating

• Pain in the testicles

Of course, these symptoms can be caused by many other conditions, including a urinary infection, BPH – Benign Prostatic Hyperplasia or arthritis, in the case of back stiffness. The prostate enlarges as men get older, and most men have some symptoms affecting urination.

Early diagnosis is important for successful treatment. There are a few tests that your GP may carry out to find out if you have a prostate problem. Firstly if your GP thinks that you might have a urine infection, they will test a sample of your urine. The GP will do this before a PSA test as a urine infection may affect your PSA level.

The prostate gland makes a protein called PSA (Prostate Specific Antigen). It is normal to have some PSA in the blood. The PSA level rises as you get older, so a man aged 70 will have a higher PSA than a man aged 50. Your GP can measure the amount of PSA in your blood by taking a sample of your blood to be tested. If there is a problem in the prostate, caused by BPH, prostatitis or prostate cancer, the levels of PSA in the blood can go up.

A rectal examination is a simple test which can be done at the GP surgery. Your GP can actually feel the size of the prostate gland by doing a rectal examination which allows them to feel the prostate for any irregularities. The examination is usually done after the PSA test because again it can affect your PSA level.

Other Tests include an ultrasound scan which can show whether your bladder is emptying properly, a urine flow test which involves passing urine into a machine that measures the speed of your urine flow, a prostate biopsy and a bone scan.

You may not have all of the tests described above. Your GP may do some of these tests or you may need to visit a doctor who specialises in urinary problems (urologist) at the hospital. If you are diagnosed with a prostate problem your GP will discuss your treatment options with you which may include surgery, radiotherapy, hormone therapy or a combination of treatments.

If you have any of the symptoms above you should visit your GP to find out what is causing the problem. However some men with prostate cancer may have no symptoms at all which is why men must be very diligent when it comes to regular screening. As previously highlighted prevention can often be better than the cure so I cannot stress enough the importance for men to book a well man check up with their local GP or medical centre. A typical check up will look at lifestyle analysis, medical history, weight, blood pressure, cholesterol, urine analysis, chest, heart and lung check and a prostate assessment. It also affords the opportunity to discuss with your GP any concerns you may have. The emphasis of a well man check up is on maintaining good health and disease prevention, a male NCT if you like!

For further information on Prostate Cancer Log on to www.cancer.ie & www.movember.com

SUNW: Male PND

Male Post Natal Depression - The name lends itself no favours in convincing an army of raised eyebrows that this gender specific condition, which for two-thirds of its name centres on an imbalance of female hormones, can in fact be suffered by 1 in 10 of the male population.

The level of scepticism associated with Male Post Natal Depression is undoubtedly attributed to its moniker, however a recent study highlighted in The Journal of the American Medical Association on the effects of Prenatal and Postpartum Depression in fathers referenced ‘Paternal Depression’ as being a poorly misunderstood condition receiving little attention from researchers or clinicians.

The birth of a new baby is a major landmark event in any couples life; however the reality of the situation can be somewhat different for new dads.

The change in lifestyle, the feeling of exclusion after the baby is born, the general apprehension of fatherhood, and of course the obvious demands and upheaval a newborn can bring can cause a great deal of stress on new fathers. Adopting the role more of the passenger than the driver, many expectant dads, though having the entire nine months to familiarise themselves with the notion of fatherhood, feel that the situation is not ‘actually’ real until they are holding their baby in their arms for the first time.

In many cases new fathers find that working during the day and coping with the ‘disruptive’ nights, particularly in the first few months, is an overwhelming and exhausting experience – one they did not sufficiently prepare themselves for. Whilst fathers in other EU countries benefit from a period of Paternity Leave, Ireland is still one of the few countries not to offer its fathers any form of Statutory Paternity Leave, thereby inhibiting them from any sort of re-adjustment to new family life which is of paramount importance in the early stages of fatherhood.

“I had no idea you could be as tired as this, for most of my working day I was in a zombie-like state unable to function normally. I am grateful to my boss for his support, the fact that he was a relatively new dad himself did help my situation, I suppose I was more of a spectator throughout the pregnancy so when the day finally arrived I was very much taken off guard” says Gary, dad of Chloe, 5 months.

While postnatal depression in mothers first came to light in the 1950s, it was not until very recently that medical professionals started applying the same diagnosis to fathers. But if post natal depression is very much a ‘hormonal’ and psychological condition, what is it exactly that man can claim to possess? One leading expert in Men’s Health, Dr. Tony Foley, explains:

“I feel paternal depression is increasingly well recognised as a distinct entity. Though not hormonal, it may be a subset of reactive depression, that is to say a depression directly attributable to an event such as the changing family dynamic, the stress, the lack of sleep, and the financial worries”.

Over-tiredness is a common foe of any new parent which can easily be written off as a result of sleepless nights, however if this is accompanied by a change in eating pattern, insomnia or unexplainable irritation, Paternal Depression could be setting in.

Other common symptoms include loss of libido, feelings of being overwhelmed, isolation and disconnection, the use of drugs or alcohol and submerging oneself in work as a part of the withdrawal. These symptoms are most prevalent in the first six months after a baby’s birth.

A dad whose partner is suffering from PND is said to be at greater risk of developing depression in the postnatal period with many female sufferers citing that their partners were showing similar symptoms as their own.

“I'd say it's probably one of the most common modes of presentation of paternal depression” Foley adds. “Furthermore, as healthcare professionals, the increasing awareness of paternal depression should prompt us to enquire both routinely (during checkups with female patients) and opportunistically, regarding paternal, as well as maternal depression”.

Men have historically been reluctant to talk about this type of depression, and statistics regarding paternal depression have only recently highlighted the problem.

The Eastern Virginia Medical School found that many new fathers experience post-natal depression, yet most cases go undetected and untreated according to the team behind the research. The findings have been based on 43 studies involving 28,004 parents from 16 different countries including the UK and the US and found that new fathers were generally happiest in the early weeks after the birth of their baby, with depression kicking in after three to six months and that at least 10% and up to 25% had post-natal depression.

They called for doctors to watch out for symptoms of post-natal depression in men as much as in women and even suggested that new parents could be offered treatment as a couple. Other studies have suggested that the figure may be as high as one in three men experiencing depression during the antenatal and postnatal period.

A similar study led by Professor Irwin Nazareth, Director of the Medical Research Council general practice research framework, studied 86,957 families who received medical care between 1993 and 2007. They identified depression among fathers by analysing diagnoses of the condition and antidepressant prescriptions.

The researchers believed that the stresses of having a child triggered the depression – such as too little sleep, changed responsibilities and extra pressures being placed on the parents' relationship. 3% of fathers suffered depression in the first year of their child's life, rising to 10% by the time their offspring was four, 16% by the age of eight and 21% by 12.

The influence of fathers during early childhood has probably been underestimated in the past. However these findings indicate that paternal depression in fathers has a 'specific and persisting impact' on children's early behavioural and emotional development. The babies of depressed men are twice as likely to suffer from behavioural problems, including hyperactivity, as they grew older as opposed to those whose fathers are not depressed.

“I can recall my wife telling her sister that I was a bit down for a while after our baby was born, shortly afterwards her sister rang me in work to berate me out of it saying that didn’t my wife have enough to worry about without looking after me as well. I have to say that I felt very ashamed, is it no wonder that men remain mute when it comes to this subject”, Gary adds.

Today’s society still dictates that men hide their emotions, quite often bottling things up in the hope that they will go away in time. The main reason that this condition is lesser known is that men often find it difficult to talk about it with some not realising that they are actually suffering from the condition.

“Unfortunately depression is wrongly regarded as a sign of weakness by some men with many being embarrassed to admit their sense of struggle. They may lack the motivation and courage to share these inner thoughts. Secondly many men aren’t regular GP attendees and don't have a real relationship with their GP. Ladies on the other hand tend to attend more frequently for their pregnancy care and subsequently with their babies for vaccinations and childhood illnesses - and so get to know their GP rather well”, Foley says.

We manage best in any new situation by being well prepared in advance of it. A new baby can be very tiring on new parents so it is very important to ensure ‘both’ parties receive sufficient rest, this is also essential in the final few weeks of the last trimester. Alternating who takes care of baby on a particular night will also allow for a better night’s sleep. Family and close friends are always at hand so don’t be reluctant to take up on the offer of a break. Consider talking to other dads who have survived the trials of early fatherhood, a little reassurance from other men will give you peace of mind that the early stages especially can be difficult and will help you feel less isolated.

Fathers should take solace in the fact that paternal depression is a common infliction, one that is perfectly normal and that you should feel no shame in being overwhelmed in the first six months of baby’s arrival.

If you are a new dad bleary-eyed from sleep deprivation and you are harbouring any of the symptoms mentioned above then it is vital that you talk to your partner. Parenthood is all about negotiation and coming up with solutions as a couple.

“I would strongly advise new dads to try to communicate with their loved ones. I'd ask them to be open to the fact that depression can affect anyone and that there should be no embarrassment or shame involved. I'd also urge them that if concerned to contact their GPs for a chat” adds Foley.

SUNW: Sex in Pregnancy

Let’s get down to it straight away - when your partner is pregnant, your sex life WILL change, I would like to say for the better but, in the ‘majority’ of cases you should expect to have a less ‘active’ sex life during the entire nine months.


But it’s not all doom and gloom, and out of a famine some fortunate expectant dads experience a feast, with a small percentage of expectant mums experiencing a heightened interest in sex, or no change whatsoever in their sexual drive during their pregnancy.

Your partner’s sex drive will yo-yo depending on what trimester she is currently in. She may spend a lot of the first trimester suffering from morning sickness making her feel less attractive and desirable, and, less likely to engage in any form of sexual encounter, with the second trimester bringing in a renewed energy and an increased desire for sex. However her sexual interest may wane again within the final trimester as childbirth nears and her body is at full capacity.

Expectant dads themselves may also experience changes in their own libido throughout their partner's pregnancy. It is understandable to have anxieties and mixed emotions about becoming a father for the first time, the financial worries, the feeling that you may no longer be the number one in your partner’s life, or that you may have sacrificed a degree of freedom that you may have had when it was just the two of you.

A large proportion of expectant dads fear that engaging in sexual intercourse may hurt the baby, or may even be self-conscious about making love in the company of your unborn child - not the type of threesome you were hoping for!

Every new dad-to-be worries about sex and hurting the baby, but sex will NOT hurt the baby. Simply put, you could be of Dublin Spire proportion...well you get the message! Rest assured your baby is safe within a cushioned amniotic fluid-filled sac and unless you're having very rough sex (did you before you got pregnant?); you have ‘almost’ no chance of injuring anyone but yourselves! In fact, in many cases, the motion of having sex will rock your baby off to sleep.

“Some men have these misconceptions about sex during pregnancy, like that he might hurt the baby or that the tip of his penis will knock up against the foetus - it won't. Some are afraid that their partner isn't in the mood, and they don't want to be too demanding. Others have trouble seeing their pregnant partner as a sexual being, or are suddenly seeing her as the mother of his child, which makes sex feel more taboo” says Dr. Yvonne K. Fulbright, relationship expert, sex columnist for Cosmopolitan and co-author of ‘Your Orgasmic Pregnancy: Little Sex Secrets Every Hot Mama Should Know’.

A lot of expectants dads feel closer to their partner during pregnancy than ever before, the fact that they can create a living thing makes ‘man’ feel all powerful and masculine!, and this closeness is often expressed in a physical way. For some, sex during pregnancy can be exciting - need I say bigger breasts? But for other men, it's literally a no-go area with some men finding the physical change a big turn off. For this band of lesser mortals may I remind you that this is after all the mother of your unborn child!

“Be supportive, even if you're not in the mood, as turning down sexual opportunities may have her more sensitive than normal. Explore other ways to satisfy her beyond intercourse if you're not always in the mood” adds Dr. Fulbright.

The way you have sex will also have to change - you may have to try new positions, especially during the last few months of the pregnancy as your partner may find the missionary position rather uncomfortable (bump) or too painful (tender breasts).

The following are the recommended sexual positions expectant couples can adopt in ensuring a safe and easy sexual experience:

• It is best to try lying on your sides, either facing each other or by spooning (rear entry position).

• The woman on top is also said to be the most comfortable of all as it puts no weight on your partner’s abdomen and allows her to control the depth of penetration.

• Enter from a sitting position - with you seated and her straddling your lap, so she has her feet on the ground and can control depth of penetration and pressure on her body.

• On her hands and knees, a good position for pregnant women because of the lack of pressure on her abdomen though some women find this difficult at the very end of pregnancy.

By all means experiment and find exactly what technique you and your partner are most comfortable with. When you're trying to think of a good position, try it, if it doesn't work, then stop. If sex proves to be uncomfortable, it is essential to your relationship that you maintain physical contact with each other exploring other options for non-sexual closeness.

“Couples should strive to maintain sexual intimacy that doesn't necessarily require all-out intercourse. This can involve sensual massages, bathing together, and cuddling. The goal should be to cultivate physical touch which acts as support for her and which nurtures the emotional bond both need in feeling closer than farther apart at this time” says Dr. Fulbright.

If sex toys are part of your normal sex life, there should be no reason to stop using them if you have a healthy, uncomplicated pregnancy. Special precaution, however, must be taken with regard to any sexual activity involving anal intercourse, ensuring that the penis, or any other object for that matter, is not inserted into the vagina afterwards.

It is generally considered that oral sex is not dangerous during pregnancy (especially for men!), however there is one exception - don't blow air into the vagina as this could cause an air embolism (blocked blood vessel) that could endanger your partner and the baby. Also, if your partner tastes ‘different’ don’t panic – pregnancy hormones can alter the taste and scent of the vagina.

There are some important circumstances, however, when you and your partner may be advised not to have intercourse.

• A history of miscarriages.

• Unexplained bleeding, stomach cramps or discharge.

• Premature contractions that might indicate an early delivery (or indeed if your partner has a history of pre-term babies).

• Multiple pregnancies (with twins, triplets or more) sex can be safe in early pregnancy, but first check with your health-care provider.

• Placenta Praevia - a condition where the placenta lies low in the uterus, blocking all or part of the cervix.

• Placenta Abruption - in which the placenta prematurely separates from the uterine wall.

• You or your partner having an active sexually transmitted disease (in which case having sex will more than likely transfer this to the baby).

• Incompetent cervix - in which the cervix dilates prematurely and can’t “hold in” the foetus.

• Serious uterine irritability or preterm uterine contractions.

• Rupture of the amniotic membranes or leaking of amniotic fluid.

Following the birth there are various issues surrounding post pregnancy sex. The inevitable demands of looking after a new baby who constantly requires feeding, changing and who has a tendency to sleep and wake when he / she wants to; for new (exhausted) parents sex is the last thing on your mind. Notwithstanding too the impact that the birth may have had on your partner’s body or the concerns you may both have with regard to getting pregnant so soon again.

Your partner is best placed to know when the time is right. Re-engaging in sexual activity can be for many new parents compared to having sex with each for the very first-time. There will certainly be an element of anxiety and apprehension which is acceptable, but try to remember what has got you both here in the first instance, these are not unchartered waters, and maintaining a healthy sex life should be of paramount importance in your relationship.

“The more couples continue to have sexual intimacy throughout pregnancy, the better their chances of reconnecting, so post-pregnancy efforts need to start in the 9 months before delivery. Once the baby is here, couples should continue to communicate about their feelings around intimacy and ease into action, still recognizing that supportive touch is going to be necessary for those times they can't - or aren't in the mood to - get all over each other. They should also plan to go on regular dates, leaving the baby with another caregiver, as happy parents make for a happy family and it's essential that they have private time together” adds Dr. Fulbright.

SUNW: Protect Yourself!

You may probably feel that you have served your time over the past nine months with the notable absence of sexual relations. You have been consistently supportive and naturally sympathetic to her predicament, but surely now that the baby has arrived you can resume where you left off and jump back into the saddle, unromantically speaking.


Stop the press my fellow man, there is a lot more to consider now than before. First off let’s dispense with the gory details as quickly as possible. Your partner has just given birth to a living being the size of a watermelon, and she may have also suffered a tear in the very place that you are eager to do business in, which needs time to heal I might add. Her hormone levels are still off course, she may also be self-conscious about her post-pregnancy body, but most importantly she is likely to be exhausted and overwhelmed from the birth so at least let her unpack her hospital bag before you decide to raise the matter again!

Your enthusiasm is to be commended especially if you were attendance at the birth, front row that is, and not in the safety zone adjacent her head, as a high percentage of men find it difficult to re-engage sexual activity with their partners after witnessing the delivery. Furthermore the impending sleepless nights and the new resident in the bedroom can often quash any sort of bump-bump, so sex may be the last thing on either of your minds when you go to bed in the eve.

It is also important to note that it is possible to become pregnant again very soon after having a baby, after 21 days in fact, and many unplanned pregnancies can actually occur in the first few months after childbirth. Being aware of all the available methods of contraception, especially as there are those that affect you, means that you can contribute more to that decision as a couple.

Abstinence

Yes, I’m serious. In plain speak: no sex equals no baby. Though, this is more suitable for the Zen Buddhist fathering types as it takes an insurmountable degree of willpower. There is no get out clause here if you get my meaning, as even ejaculation without penetration can still lead to pregnancy.

“I think it became abstinence by accident, we were both so tired, it was the last thing on both our minds, the topic of contraception didn’t come up until well after our baby was in his own room and life began to return to normality, sure I missed the intimacy but we were thankful of the rest” says Mark Higgins, father of one.

On the opposite spectrum to abstinence is the natural method of contraception which involves your partner determining when she is most likely to get pregnant, and then avoiding sex during these times. By keeping a detailed record it tells her when she is most fertile and to take extra measures to avoid pregnancy. It has the advantage that no chemicals are used and also allows couples who want to get pregnant to know when the best time to have sex is. Understandably the figures for its effectiveness vary as it is heavily dependent on preciseness, mutual co-operation and determination on both partners’ parts.

Building Barriers

Barrier methods include male and female condoms, diaphragms and caps. To avoid discomfort during intercourse it is best advised to use an additional lubricant with condoms to help make sex more comfortable for your partner. A diaphragm or cap is a flexible rubber or silicone dome which is inserted into the vagina before intercourse. A spermicide is often used with this method to destroy sperm.

“I was never really a fan of condoms - it felt like being a teenager again, but my wife was breastfeeding at the time and we both felt that this was the best and safest method which did not affect the breast milk in any way” says Tim Reilly, father of two.

The Pill & Mini Pill

Around since the 1960’s it is still the most popular form of female contraception. There are a large number of pills available, most of which contain two different hormones (oestrogen and progestogen) and are taken daily at the around the same time for three weeks followed by a week’s pill-free interval. They are suitable for most women, but should not be taken by breastfeeding mothers. Women over 35 should check with their GP first. The ‘mini-pill’ however can be taken by women over 35 or breastfeeding mothers, as it only contains the one hormone – progestogen.

The Implant

An implant is a small device containing the female hormone progestogen, similar to a matchstick; it is placed under the skin on the inside of the upper arm. It involves a minor surgical procedure which can be performed by most GPs. The main advantage of the implant is in its effectiveness (99%) and the fact that once it is in place you do not need to think of contraception for three years, however the possible side effects for your partner may include irregular bleeding, weight gain and skin problems.

“I considered this to be joint decision and one I didn’t want my wife to make on her own so I accompanied my wife to our GP’s office to discuss all the options. We felt the implant was best suited so my wife made an appointment with the GP to return the following day for the procedure. Six months on we are both happy, my wife is also thankful of the lighter periods” says Thomas McHale, father of two.

Injectable Contraception

Usually given in the bottom it gives your partner protection from getting pregnant for up to 12 weeks, but she must have regular injections in order to stay protected. It has a similar side effect profile to the implant and some women also find that it takes some time for their fertility to return when they stop using it.

IUD & IUS

The coil or intrauterine device is a small T-shaped plastic and copper device that is inserted through the vagina into the womb usually by a GP. The IUD is a long-acting reversible contraceptive (LARC)which means that once it's in place, your partner does not have to think about contraception every day or each time you both have sex. An IUD can last from three to 10 years and has 99% effectiveness. Changes to your partner’s periods are common resulting in lighter to none altogether. On the other hand an intrauterine system (IUS) is a plastic device that contains a progestogen hormone. It is put into the uterus in a similar way to an IUD and can last up to 5 years.

The Patch & Ring

Both of these methods contain similar hormones to the pill, have the same benefits and frequency of use but have the added bonus of not being needed to be taken daily. The contraceptive patch is stuck on to the skin whilst the ring, a plastic see-through flexible device, sits inside the vagina for three weeks every month. As both contain the female hormone oestrogen they are not a suitable method of contraception for breastfeeding women.

Breastfeeding

Breastfeeding can act as a contraceptive in itself when your partner is without a monthly menstrual period and is fully breastfeeding a baby under six months old. Even if your partner is breastfeeding it is recommended that she speak with her GP regarding other contraceptive options and the safety implications of each method.

Sterilisation

More than 99% effective, male or female sterilisation may be appropriate when a couple decide to choose to have no more children. In the case of female sterilisation the fallopian tubes are cut or blocked so the eggs cannot travel down to meet the sperm. A Vasectomy however is said to be easier as female sterilisation can involve a hospital stay and the operation usually requires a general anaesthetic. A vasectomy works by preventing sperm from reaching the semen that is ejaculated during sex. It is usually considered to be a permanent form of contraception, although in ‘some’ cases the procedure can be reversed. It is a quick and ‘usually’ painless surgical procedure which is carried out under local anaesthetic.

“After everything my wife has gone through with the pregnancies it was the least I could do. The sex is still the same; in fact if I must admit it is a little more adventurous now, it really makes no physical difference whatsoever. The procedure itself did feel like I had been kicked in the groin but the pain didn’t last too long” says Richard Byrne, father of four.

Please consult with your GP for further information and to discuss the suitability and side effects of each listed above.