1 Min In Clinical
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Learning objectives
After reading this feature you should be able to:
- Identify lifestyle advice to improve men’s health
- Tailor your pharmacy to enable you to engage more effectively with men
- Manage some of the more common health conditions affecting men.
Many men — some studies suggest as many as eight in 10 — would rather suffer in silence and even put their lives at risk than engage with healthcare professionals.
With recent research suggesting that around one in four men in the UK actively avoid a consultation with a pharmacist or doctor about a health issue, is it any wonder that 20 per cent of the male population will die before they reach the age of 65 years?
When men do manage to pluck up the courage to talk to a health professional, the top 10 sources of discomfort concern discussions about:
- Sex-related genital complaints
- Non sex-related genital complaints
- Rectum – anything that requires a stool sample/internal examination
- Mental health
- Urine infections
- Bad breath and wind
- Snoring
- Weight issues
- Bodily odours.
Behavioural studies and anecdotal evidence show that embarrassment remains one of the main reasons preventing men from making that all-important appointment. Other reasons include claiming they are too busy, worried about time-wasting, being a burden on the NHS, or unable to get an appointment around work hours.
Dr Graham Easton, a GP and professor of medical education at Queen Mary, University of London, says men find it difficult to talk about any health problems and often leave it until crisis point before plucking up the courage to book an appointment.
“I think sometimes men are worried that we might need to do some sort of intimate examination – a finger up the bottom or an examination of the testes, for example – and would rather leave going to the GP until they feel their symptoms are too serious to ignore.
“Many men are afraid that if they go to the doctor they will discover something bad, like a cancer. That fear is often enough to make them delay or avoid making an appointment in the first place.”
He acknowledges that there are also often practical issues at play, such as difficulties in arranging a convenient appointment or pressure not to miss work. “I have experienced this myself recently, waiting for more than half an hour to get through on the phone. It is a big time commitment and it can be disruptive,” he says.
This unwillingness to pick up the phone or go online to book an appointment often leads to the inevitable Google search and attempts at self-diagnosis, which carries its own set of dangers.
When men finally do make it through the door, their opening lines usually gave a good indication of why they were so reluctant to seek advice in the first place, says Dr Yang Ooi, a GP and lecturer in clinical skills.
“Consultations with male patients often begin with comments such as ‘My wife nagged me to see you but I think it’s a waste of your time really’; ‘This is a bit embarrassing but...’ or ‘My wife made me come because I am snoring so loudly she can’t sleep. She is threatened to divorce me if I didn’t!’”
Pharmacy and cancer
Earlier this year, a community pharmacy cancer diagnosis pilot was launched in England. People with symptoms including a cough lasting for three weeks or more, difficulty swallowing or blood in their urine can now be referred for scans and checks – without needing to see a GP – if pharmacy teams think it could be cancer.
“Earlier diagnosis of cancer gives a better chance of successful treatment,” says Helga Mangion, policy manager at the NPA. “As a highly accessible healthcare setting, pharmacies can play an important role in spotting signs of cancer and making appropriate referrals into NHS care.
“The cancer diagnosis pilot is a great opportunity to further expand the clinical role of pharmacy teams, increase early detection rates and improve outcomes for patients.”
The most commonly diagnosed cancer in the UK is prostate cancer, which has overtaken breast cancer a decade earlier than experts had predicted. Each year, around 52,300 men are diagnosed with the disease and one in eight men are likely to be affected in their lifetime.
Prostate cancer is often asymptomatic in its early stages so can be difficult to diagnose. It is not always life-threatening but the earlier it is caught, the better. It mainly affects men over 50 years of age and the risk continues to increase with age, although this is not the only factor.
If a close family member, such as a father or brother, gets prostate cancer, that could increase a patient’s own risk. Men are advised not to wait for symptoms if they want to discuss if they might be at risk.
When symptoms do occur, these can include changes in urine, erectile dysfunction and, less commonly, lower back and hip pain.
Community pharmacy teams can play a crucial role in educating men about the signs and symptoms of prostate cancer and raise awareness of the prostate specific antigen (PSA) test, which measures the amount of PSA in the blood. A raised PSA level may suggest a problem with the prostate, but not necessarily cancer.
If prostate cancer is diagnosed, pharmacy teams can play an active role after treatment, advising the patient on issues such as incontinence and other treatment side-effects. However, treatment for prostate cancer will depend on individual circumstances. For many patients, no treatment will be necessary.
Common conditions
Male pattern baldness typically begins with a receding hairline, followed by hair loss around the temples and crown. Hair loss can cause significant emotional distress in men.
There is no cure for male pattern baldness. It may be treated with finasteride tablets, which are available on private prescription, and topical minoxidil, which is available over the counter. Men usually need to take finasteride every day for at least three months before they notice any benefits.
Minoxidil needs to be applied directly to the affected areas of the scalp twice a day, every day. It works by increasing the blood flow to the scalp. Most men using minoxidil don’t notice any benefit for at least six months. The benefit is only maintained while both treatments are being used.
Erection problems are particularly common in men over 40 years of age.
It is usually nothing to worry about and may be triggered by stress, anxiety or too much alcohol but persistent symptoms may be a sign of an underlying physical or emotional problem, including cardiovascular disease.
Although erection problems are more common with increasing age, it is now frequently the case that younger men are affected due to worries over health, finances or work.
When talking to a patient, it is important to appreciate the impact erection problems can have on a man’s confidence and relationships. Explain that erectile dysfunction can sometimes be improved with lifestyle changes, such as weight loss, smoking cessation, reducing alcohol consumption, regular exercise and stress management.
Sildenafil, available over the counter, is indicated to treat erectile dysfunction in men over 18 years, as long as they meet certain criteria.
As men are encouraged to be more physically active, they may be prone to sporting injuries, especially if they aren’t used to exercise. Sprains and strains can cause pain, inflammation and bruising. Minor injuries can usually be treated at home by following the PRICE procedure. If customers are looking for pain relief, offer paracetamol or NSAIDs or suggest using topical products. Severe or persistent symptoms may require advice from a physiotherapist.
Men may have problems passing urine, a frequent need to pass urine and/or a poor stream of urine. Lifestyle changes may help in mild cases, such as avoiding drinking liquids at night (especially caffeine-containing drinks), avoiding constipation, drinking plenty of fluids during the day and avoiding anything that irritates the bladder, such as spicy foods.
Male incontinence may be a sign of a urinary tract infection, obesity, diabetes, a neurological problem, or a side-effect of certain medicines (e.g. antidepressants or diuretics). It can also be a sign of prostate problems, such as benign prostate hyperplasia (enlargement of the prostate gland). The pharmacy team can recommend suitable incontinence protection products but men should be referred to their GP if symptoms persist.
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