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- [00:00]
Dr. Renamelic
Welcome back to Ask Me Anything. This is our episode where we answer our subscriber questions, our member questions. If you're interested in becoming a member so your question can be answered, make sure to check us out@supercast renamelic.com so you can ask your questions. Get early access to our podcast episodes as well as transcripts from the podcast. Without further ado, let's get to it.
- [00:19]
Subscriber/Listener
All right, first question, let me just say up front, I am not asking this for any philosophical or religious reasons. I'm a 45 year old man and I'm uncircumcised. I do wonder if there are any benefits to me getting a circumcision for medical reasons. What are perks of getting one, and what are some negatives?
- [00:41]
Dr. Renamelic
So circumcision is a surgical removal of foreskin on the penis. Sometimes it's done for religious purposes, sometimes it's done for personal preference reasons. But ultimately, as an adult, what are the reasons that men undergo circumcision? So there's a few what one can be if you're getting recurrent episodes of balanitis or infection under the foreskin that you know you're struggling with. So that often can be a sign that getting a circumcision would alleviate that problem and you wouldn't have further risk of infections. That's one, Two is if you're getting phimosis. So phimosis is where you're unable to retract the foreskin. Now, this is not inherently dangerous, but over time, if you're unable to retract the foreskin, you can't see underneath it. There's also a increased sort of smagmar formation inflammation. Those sorts of things can put you at a slightly higher risk for something like penile cancer. Now, penile cancer is very, very rare, but ultimately it is something that we want you to be able to look at your glands and the entirety of your penis and make sure there's no signs of changes or abnormalities on the penis. And so when you have phimosis, that can limit your ability to do that. Also, sometimes when you have phimosis, it can be painful because the penis can have pain when getting erect. Particularly if you find yourself being in the camp of growers, you might notice it's actually uncomfortable because your glans is stuck behind the foreskin and it makes getting an erection a bit painful. And for those reasons, you may want to get a circumcision. Another condition that might put you make you consider a circumcision is something called lichen sclerosis. This is a skin condition that results in changes of the skin to leave the sort of whitish patches on the skin that make it sort of. Sometimes it's painful, sometimes it may make it look unesthetically pleasing, sometimes it can cause difficulty with urination if it's on the tip of the. The penis. But when it involves the foreskin, sometimes doing a circumcision can be curative or at least improve the condition altogether. So there are reasons to do it, in terms of general reasons people do it as a whole is it can reduce the risk of STIs, particularly HIV. And so that's another reason that sometimes people consider getting a circumcision. Now, in terms of benefits of a circumcision, benefits are basically, you're alleviating those issues I talked about, right? So you're going to have an easy. You're not going to have to worry about retracting your foreskin. You're going to be able to see under your foreskin. You're at lower risk for both balanitis and sexually transmitted infections. And for some people, when they're having pain with sex, they actually find that their sex life is significantly better after getting a circumcision because they're no longer dealing with this pain. In terms of risks, what people really worry about is what is going to change my sexual experience, and it's going to particularly change my sensation. Now, after you get a circumcision as an adult, for the first, you know, one to three months, you are going to have changes in sensation, right? Because you've had foreskin covering the head of your penis for your entire life, and now all of a sudden we've removed that and your glands or your head of your penis is exposed to your boxers or your underwear. And so people will feel hypersensitive during that first healing period. That usually improves over time. They've done some large trials looking at adults who've undergone circumcision and compared their sexual function before and after sur circumcision. And what they found was that there was really no significant difference in sensation, in ejaculation, in erectile function, in the presence of premature ejaculation, any of those things. There was really no significant difference. And so that's really reassuring in saying, hey, we're looking at this large population of people and we're not seeing a difference. Now, I want to be thoughtful because there are people who really do feel like their sensation changes or they've had changes in sexual function after circumcision and that is a totally valid. Valid and real experience. So the risk is that, yeah, could you have an experience that's not typical? Yes, absolutely. Could you have hypersensitivity that persists potentially. But really the biggest thing that I see is that people are a little bit dissatisfied with the way their penis looks. You get very used to looking at your penis a certain way, and when you get a circumcision, it drastically changes the way your penis looks, particularly if you have a lot of foreskin. And so that can lead to dissatisfaction. So ultimately, I recommend getting one if you have any of those conditions and if you've really seriously thought about the risks and benefits. While it is a pretty straightforward procedure and the risk of having a side, you know, an injury or an untoward complication is very low, it is still a procedure. And even if the risks are low, if something happens to you, it happens to you and your experience is valid and important. So bottom line, if you want a circumcision for any of the reasons I've talked about, it's absolutely indicated. If you want one for, you know, cosmetic reasons, that's also fine. But again, just be well informed. Talk to your physician. Make sure you understand what your experience is going to be after the circumcision and how it's going to take place. One last thing. A lot of times we'll do this with patients awake in the office because we can numb the penis quite well and you don't have to undergo anesthesia. So that's another important thing to talk with your doctor about if they do that in the office or if they take you to a surgery center and what your preference might be. So talk to your doctor about that. Talk to your doctor about what to expect after the circumcision and, you know, their personal experience doing circumcisions and how they handle it. And make sure you're fully informed before you proceed with any surgery.
- [06:05]
Subscriber/Listener
All right, next question. When I was in my 20s, I would get turned on by my boyfriend and it felt like a rain shower was in my pants. That's how turned on I would get. Exclamation point. But now that I'm a 50 year old happily married woman, I'm noticing the plumbing isn't the same. I still love my husband to death, but my downstairs doesn't do the same rain shower like it used to. Sometimes I feel guilty because, quote, is my body saying, I am not attracted to my man, end quote. What can I do to improve this? Or can I expect it to turn Into a desert down there when I get into my 60s.
- [06:46]
Dr. Renamelic
Great question. So, one, I think, you know, it is very normal experience for a lot of women to experience changes in lubrication after menopause. Now, menopause average age is 51, and that means that half the people will hit menopause before 51, and half people will have menopause after 51. And so what happens happens during menopause. And how do you define it? First, that is not having a period for 12 months. So the absence of menstruation for 12 months equals menopause. But that doesn't mean your symptoms just start around then. They can start as early as four years, four to seven years before menopause, and then they will continue, particularly when it comes to what we call the genitourinary syndrome of menopause. So what is that? Right? That includes this dryness that this person is experiencing. So when you undergo menopause, what happens is your estrogen drops very, very low. And so what that means is that you no longer have estrogen activating the receptors in your vulva and vagina. And that leads to a decrease in lubrication. It also leads to shrinkage of the labia minora or the inner lips of the vulva. It also leads to sort of sometimes shortening of the urethra. It may also cause changes in the clitoral hood or the covering of as well as the clitoris itself. And importantly here, the lining or the skin of the vagina changes. It becomes more thin, potentially more friable, and it makes less lubrication. And the cause of this is hormonal. And so this can happen very, very commonly. And the thing about it is, unlike hot flashes, which last for up to 10 years during menopause and then go away, this doesn't happen with these symptoms for lack of estrogen. The genitourinary syndrome of menopause continues to throughout your as you age and sometimes can get worse. And so sometimes what you'll see is that you're fine, you're fine. All of a sudden you're noticing some dryness. You can also notice that you're developing recurrent urinary tract infections. And this can be very easily treated. All of these things can be very easily treated with vaginal estrogen, which is very safe and effective. Vaginal estrogen is essentially using topical hormonal cream, suppository or ring in the vagina that creates more estrogen in those tissues. Only a very tiny amount gets systemically absorbed into the bloodstream. So most of it just stays local in those tissues and it can help reduce that discomfort. If you're having pain with sex, it can help increase lubrication and it can help with just generally keeping the health and nourishing those tissues.
- [09:24]
Samantha Christine
Hey guys, I'm Samantha Christine, host of the Empower Podcast right here on the Pursuit Network. If you're into wellness that fits into real life with honest convos, workout tips that actually make sense, nutrition hacks that support your lifestyle, and a lot of encouragement to become your strongest self, you'll feel right at home on my show. Whether you're a busy mom in a season of rebuilding or just trying to stay consistent with the all or nothing mindset, the Empower Podcast is for you. New episodes drop every Wednesday wherever you listen to podcasts. So come hang out. I'd love to have you lose over time.
- [09:55]
Dr. Renamelic
It is very, very safe. It is very effective. There's very few contraindications to vaginal estrogen. Only if you've have active breast cancer is vaginal estrogen contraindicated. Otherwise, if you've had breast cancer in the past, or you've had blood clots or any other issues that you might be concerned about, vaginal estrogen is completely safe and effective. So that's one way. And the other thing I want to point out here is that while menopause is a very well understood time of low estrogen, there are other times in life where you might notice that you have less estrogen. One being if you're lactating, so you just had a baby and you might be breastfeeding sometimes with certain medications that can mess with your hormonal milieu and cause decreased estrogen. And so the amount of lubrication you make is not always indicative of how aroused you are, how turned on you are with your partner. So I want you to be reassured and reassure your partners and all the men who are listening that if your partner's going through a time of low estrogen and their lubricant is less, that doesn't mean that they don't like you. It just means that they are having a hormonal change, right? And that can be treated. The other thing is obviously use lubricant. I can't say this enough. Lubricant should be used by everyone. It is safe, makes sex more fun, more pleasurable. And I've made videos about lubricant. I'll make sure to link those in the description in the show notes. So you can check those out, but essentially try them, you will find that it will enhance your sexual experience and make things more fun.
- [11:20]
Subscriber/Listener
So no fear. You may. You might be going through some menopause, but if you still love your husband, that's a good thing. Next question. What's the difference between a UTI and prostatitis? I am a dude and I always thought only women get UTIs. My older brother has prostatitis and he had to have catheters put in him but I had to go to the ER recently and I thought it was going to be prostatitis too because it hurt when I tried to pee. But the nurse practitioner said it was a uti. Is there a difference between a UTI and prostatitis? Like this, this question of men getting a uti for some reason there's a myth out there that men can't get UTIs. I've seen this in other comments. So what do you say? What's the difference between UTI and prostatitis and what are they?
- [12:10]
Dr. Renamelic
Yeah, absolutely. So prostatitis is defined as the inflammation of the prostate, right? And so you can have infections that arise from the prostate which is acute or chronic bacterial prostatitis, but you can also have non bacterial causes of prostatitis. Now what is prostatitis? Right. It is a discomfort or pain that that is attributed to the prostate which is in the pelvis that lasts for some period of time. Now when it's acute, it's very acute onset. It's usually with high fevers, pain, sometimes difficulty urinating and usually during that time you'll need antibiotics. When you have chronic bacterial prostatitis that is usually lasting for about six weeks or more and that is again when you have these symptoms. You might not have fevers, but when we do an evaluation we find that there is a signs of bacterial infection and then a uti. Urinary tract infection is an infection arising from the urinary tract. So the source can be the bladder, the kidneys, most commonly the kidney stones or bladder issues or incomplete emptying of the bladder, which happens to men a lot. And I'll explain, but basically they're two different sources of infection sometimes, but they can be somewhat similar in how they present. So for simplicity's sake, let's just talk about bacterial prostatitis versus uti. So bacterial prostatitis is when you have bacterial infection of the prostate. Now this is typically figured out because either you have very clear signs and symptoms of prostatitis like an acute bacterial prostatitis and we treat you without A prostate exam, because we don't want to examine the prostate and cause that bacteria to then translocate or get into the bloodstream and cause you to get very, very sick. And so those are very sort of typical signs and symptoms that we see when we treat you for the prostatitis. Now, if you have chronic bacterial prostatitis and a UTI and you can't tell most of the times, we'll examine you with a prostate ex. Oftentimes if your prostate is tender, meaning when we do the prostate exam, it hurts, that tells likely that it is prostatitis. We also can do sort of a post prostate massage urine collection to see if we find any bacteria in the urine. But a UTI would be just collecting urine and assessing for a urinary tract infection. Now, the UTIs typically present with symptoms of bladder pain, pain with urination, going more urgently, going more frequently. Sometimes you might have pain in the kidneys or flank pain, sometimes you can get fever, things like that. When you have prostatitis, it's typically pain in the pelvic region. That's a symptom that you're having most often pain in the pelvic region. Sometimes it can cause pain with urination, sometimes not. But it's mostly pain in the pelvic region. Men can get UTIs. So as I mentioned before, why do men get UTIs? The most common reason is because they are not emptying their bladder completely, and that's because of an enlarged prostate. Now, if you're new to this podcast or this channel, I have talked about BPH or enlarged prostate so many times and I will share a bunch of videos where I've talked about BPH so you can learn more about it. But essentially an enlarged prostate is very, very common. If you look at 80 year olds, 80% of them will have an enlarged prostate. And when you have an enlarged prostate, it essentially decreases the flow of urine out from your bladder and sometimes makes it more difficult to empty. Now, when you have urine sitting in the bladder that doesn't empty, that becomes food for bacteria, which puts you at higher risk for UTIs. And so in those cases, we treat the UTI, both UTIs and bacterial prostatitis treated with antibiotics. But then we essentially want to investigate what's going on. Is this caused by incomplete emptying or might there be something else like a kidney stone? And so we do an investigation and if we find that it's from an enlarged prostate, then we try to treat that issue or help you empty your bladder better. So you stop having UTIs. But to answer your question, UTIs are not just for women. Men get them too. They get them less commonly because they have a longer urethra than women. But they do get them them in these circumstances where maybe they're not emptying their bladder completely, or if they have neurologic conditions that they may need to catheterize or other issues like that.
- [16:17]
Subscriber/Listener
All right, next question. I can't seem to pee straight anymore. I can't even remember when this started, but when I used to have a nice dream with decent aim. Now I just have pee, and it goes all over the place. Even if I hold the penis in the direction of the toilet. I don't think think I had any kind of injury because I have no symptoms like pain, but the stream is wacky. All right, well, let's see what, what to do for this wacky stream.
- [16:47]
Dr. Renamelic
Wacky stream. So this is more common than you'll realize, and there's a few reasons. So one, you said injury. He mentioned injury in his question stem. So sometimes you can get what's called a urethral stricture or narrowing. Now, this can happen due to some sort of injury or if you've had a procedure, urologic procedure, and you had some scarring in the urethra, sometimes that can be a cause. If you've had a sexually transmitted infection for a long period of time that wasn't treated, you can develop urinary strictures. And so if you develop a urethral stricture, it's essentially like, think about you're using a hose. When the hose is wide open, the stream from the hose is straight. But when you put your thumb on it, because there's a stricture, right? That's basically a stricture, the stream goes all over the place. So very similarly, if you have anything blocking the flow of urine, it will cause your stream to go wacky. And so in this case, it's probably not a urethral stricture, but you do want. That's on the differential, meaning that's one of the things that could cause it. It can also be caused by an enlarged prostate. And so when you have an enlarged prostate, that blocks the flow of urine, which can cause sort of a wacky stream. The other thing is sometimes if you have just recently ejaculated, you can have some leftover remnant semen in the urethra or the P tube, and that can function the same way. It can cause turbulence when the urine flows, making the stream go wacky. Now, it's not dangerous, right? It's not dangerous if your stream is wacky, it's just more of a nuisance. So if you but if you are bothered by it, absolutely see your urologist. So we can assess and evaluate which of these things might be causing your stream to go awry and we can address them and hopefully help your urine stream improve. Thank you guys for joining us on today's episode of the ama. If you want to hear the rest of this episode, make sure to sign up for our Premium membership@renamelic.supercast.com where you can ask me anything. You can get early access to all the podcast episodes as well as get transcripts from the episodes. And just support what we do here because we love being able to give you educational content and this is a great way to support and we appreciate you so much. And as always, we're going to take care of yourself because you're worth it.
- [18:57]
Samantha Christine
Hey guys, I'm Samantha Christine, host of the Empower Podcast right here on the Pursuit Network. Work if you're into wellness that fits into real life with honest convos, workout tips that actually make sense, nutrition hacks that support your lifestyle, and a lot of encouragement to become your strongest self, you'll feel right at home on my show. Whether you're a busy mom in a season of rebuilding or just trying to stay consistent with the all or nothing mindset, the Empower Podcast is for you. New episodes drop every Wednesday wherever you listen to podcasts, so come hang out. I'd love to have you.