Men should have a regular check-up with a urologist – but most shy away from the visit. Why is that?
Going to the urologist is a challenge for many men where they seem to lose their usual bravery. In a recently much quoted Study by Plan International Around half of the men surveyed between the ages of 18 and 35 stated that they ignored health problems. And when it comes to pension provision, the majority of men are lagging behind. Neglected check-ups can have serious consequences – especially in the field of urology. Urologist and author Dr. Christoph Pies (“Don’t be afraid of the urologist”, Kosmos Verlag) in an interview with the news agency spot on news.
Why do so many men shy away from visiting a urologist?
dr Christoph Pies: According to surveys, three out of four men have a pronounced fear of illness, but still do not allow the examinations that are offered to be carried out for fear of a bad diagnosis and the resulting consequences. After all, illness means weakness and that doesn’t fit into the role of a strong man.
And so the man develops avoidance strategies: On the list of excuses for visiting the doctor, lack of time is number one, followed by fear of a bad diagnosis and respect for the prostate examination with the finger. Men attend health check-ups significantly less frequently than women. The provision rate for women is over 40 percent, for men just over 20 percent.
What exactly does a standard urological examination involve?
dr Pies: The examination includes palpation of the testicles and groin and inspection of the genital area for inflammation and changes in the skin, as well as an assessment of the urethral opening and (from the age of 45) palpation of the prostate with a finger from the anus.
“Little Harbor Tour” is the slang term for this rectal exam. The urologist feels the prostate and the rectum with his finger to find out whether tumors can be felt on the prostate.
Statistically, we only discover one out of ten existing prostate tumors. Namely those that sit on the outside of the prostate. Currently we can only get closer to what is happening inside the prostate by determining the so-called PSA value in the blood. However, you have to pay for this yourself.
Why is it so important to have regular check-ups and how often should you do it? Which check-ups shouldn’t you miss? From what age should you come for the examination?
dr Pies: I think the routine checks recommended and paid for by the health insurance companies are absolutely sensible!
The man is currently legally entitled to the following examinations:
Boys between the ages of 9 and 17 should be vaccinated against HPV, because human papilloma viruses can cause viral warts in men and precursors of cervical cancer in women. The vaccination is usually done by the pediatrician. In a man, the viruses only cause unpleasant warts, but with the vaccination he protects his sexual partners from cervical cancer.
Men over the age of 20 should also feel their testicles regularly. Testicular tumors are statistically most common in early adulthood. Fortunately, this is a cancer that in most cases can be completely cured. There is currently no scheduled check for testicular tumors by the health insurance companies. Therefore, young men should regularly feel the testicles themselves! Directions: https://www.hodencheck.de/
From the age of 35 there is a health check-up every three years at the family doctor (cardiovascular system, diabetes and kidneys, urine test and extended blood test with fat values), as well as a skin cancer screening every two years.
At the age of 45, the actual urological care begins. A physical examination with palpation of the groin, penis, testicles and prostate is recommended annually. If you have a family history of prostate cancer, you should start as early as 40.
Colon cancer screening begins at the age of 50, which includes either an annual test for hidden blood in the stool or two colonoscopies ten years apart.
From the age of 60 one should not forget the flu vaccination and pneumococcal vaccination and at the age of 65 an ultrasound is carried out to check for enlargements of the abdominal aorta.
In addition, there are also additional examinations such as the prostate cancer test PSA, which can also make sense in individual cases.
Many men only go to the doctor when they have acute symptoms. What are typical symptoms that men come to you with?
dr Pies: Whether and when you see a urologist is also a question of generations. In particular, those over 50 usually still have the attitude: if something is broken in the body, then I will have it repaired. Before that, I ignore many signs of illness. And if an acute problem arises, I can always go to the doctor.
The lack of health awareness is based on a mixture of a lack of risk competence, short-sighted thinking and repression mechanisms. Mental illnesses in particular are pushed aside and underdiagnosed. On an organic level, middle-aged men often have inflammation of the prostate and from the age of 50 they also have problems urinating due to an enlarged prostate.
Young men, on the other hand, are becoming increasingly health-conscious. Which sometimes turns into the opposite: An example: I see the clinical picture of “overtreatment balanitis” almost every day. This is an inflammation of the glans caused by too much hygiene. Mostly in younger men who have destroyed the normal skin flora, i.e. the protective layer of the skin, by intensively washing with soap or shower gel several times a day.
Many types of bacteria, viruses and fungi usually coexist peacefully on the glans. Too much hygiene destroys their balance and the fungi gain the upper hand because they are the most resistant. Then the typical redness with a whitish coating develops. Then the man thinks I haven’t washed enough. And then he washes even more intensively. This will only make things worse.
Young men also often come out of fear of STDs, or concerns about testicular cancer, especially after four professional soccer players fell ill with testicular cancer in 2022.
Potency disorders, on the other hand, occur in all age groups, but also increase significantly with age. Potency disorders often have a mosaic of causes, both organic and psychological factors play a role. And these influence each other. In recent years I have seen an increasing number of young men who have had erectile dysfunction due to increasing pressure to perform at work, due to problems with their couples, due to excessive sexual expectations.
What questions do you hear most often from your patients? What question(s) do most men have?
dr Pies: The most common question is, “Is that something bad?” Especially with regard to testicular and prostate cancer. But often – due to shame and insecurity – the real problem, why the man is in my office hours, only comes to light in the course of a trusting conversation…
Young men are often insecure about “normal sexual function” in terms of the size and appearance of the penis – the curvature or things like that. There are inflated expectations and misjudgments in many respects. The average sexual intercourse in Germany, for example, only lasts five minutes. When men are questioned, they estimate it to be up to 30 minutes in retrospect. And every fifth man classifies his ejaculation as premature.
And then, of course, the big topic of potency. Potency problems lead many men to the urologist for the first time – but only when the level of suffering is high enough. Sometimes it is also the suffering of the partner that ultimately leads to a visit to the urologist. Usually the man only opens up when he is actively asked about it by the doctor. Once this start has been made, a great deal of openness and gratitude can develop, because the patient feels that their complaints are being taken seriously and can also be treated.
Are Most Men Happy With Their Penis? How present are the topics of size and appearance in your office hours?
dr Pies: The topic is very present among young men in particular. For information: On average, the penis is nine centimeters long when at rest and about five centimeters when fully grown. One should always be aware that with a mean value, half of the population naturally ranks below this value. Except nobody wants to be part of that half! In a survey of over 25,000 men, only 55 percent were satisfied with their penis size, and 45 percent wanted a larger penis. Pornographic representations convey false ideas of a supposed “norm”. The demand for penis enlargements has increased noticeably in recent years.
In your book “Don’t be afraid of the urologist” you describe the penis as the “antenna of the heart”. What exactly do you mean by that?
dr Pies: It is meant as a metaphor: an erectile dysfunction can be a first important indication of the development of circulatory disorders, from which vascular damage in other organs such as the heart or brain can be concluded. Erectile dysfunction and its symptoms precede a heart attack or stroke by an average of two to three years. The penis is therefore a very effective early warning system for circulatory disorders! This alarm signal must be taken very seriously, especially by smokers! Hence the antenna metaphor.