At The Forefront Live: Men's Wellness

When people think of men's wellness, they often think of urology issues. But it includes much more than concerns about erectile dysfunction and incontinence. Dr. Sarah Faris and Dr. Omer Raheem join us for a discussion about the new Men's Wellness Clinic at UChicago Medicine, which takes a broader perspective on men's general health, including cardiovascular, endocrinology, fertility, and cancer support services. Plus, we'll take your questions. That's coming up right now on At the Forefront Live.

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And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. We're going to start off with each one of you introducing yourselves to our audience and telling us a little bit about what you do here at UChicago Medicine. And Dr. Faris, you drew the short straw. You had to sit at the desk. So we'll start with you.

Perfect. Well, my name is Sarah Faris. I am an Associate Professor of Urology at University of Chicago. And my specialty is in male and female reconstructive surgery. So I focus on both male and female incontinence and things like urethral strictures and ureteral strictures, erectile dysfunction, and prosthetics, among many other things.

Dr. Faris, let's talk a little bit about ED and incontinence. Those are two issues that you mentioned that you do surgery on for both men and women. But those are some pretty significant issues. And I noticed I know a lot of men that after they have, for example, prostate cancer, prostate cancer surgery, or some of the other types of prostate cancer fixes, these can be issues. Can you talk to us a little bit about that?

Absolutely. So we have a phenomenal oncology section here with our urology department. We do a lot of robotic prostatectomies and work very closely with our oncologists and our radiation oncologists as well. But it's not always 100% where people don't have side effects from it, such as erectile dysfunction or incontinence. And that's where Dr. Raheem and I come in. It's one of the things that actually drew me to urology-- was the quality of life aspect-- because erections and sexual intimacy is an incredibly important aspect of people's lives.

And urinary incontinence-- you pee multiple times a day. And if you have leakage and need pads and you're worried about having an accident-- I had a patient the other day who was talking about how he always has to wear dark pants whenever he goes on the golf course. And even then, he's very concerned about the embarrassment of having an accident.

So it's an incredibly impactful piece of the puzzle in all of this. And I think one of the things that's great is having Dr. Raheem and myself to help support patients through their entire journey.

So what exactly happens when-- and I gave the example of prostate cancer because that's something we talked about the other day when we were doing our preshow prep. What happens to men when they do have that surgery or some of the other treatments that happen with prostate cancer that cause these issues?

Well, the neurovascular bundles that help with erectile function run along either side of the prostate. And then depending on the prostate cancer characteristics, whether or not it may involve some of those neurovascular bundles or it's more contained within the prostate, our surgeons come up with a very specific plan about whether or not and how much of those bundles they can save.

But sometimes, if the cancer is starting to invade outside of the prostate, they have to remove those bundles as well to get a good cure for the cancer. So that's one piece of it. That especially affects the erectile function portion of it.

For the urinary incontinence piece, for men, your prostate acts as your main continence mechanism. It's very different for women, which is why stress incontinence is much more common, because we just have our external sphincters. Most men have never had to use it before. So there's a big degree of learning how to reuse that. But also, if those muscles aren't as strong or the resection is really close to it, we don't know the exact mechanism, to be honest, of stress incontinence. But it is one of the things that can happen afterwards.

In a way, that's one of your big valves, I guess, that exist in men. You've got more than one, but that's--

Yeah, exactly.

I got you.

Exactly.

Dr. Raheem, I think we may have a new microphone on you now. So we're going to give this another try and see if we can hear you. And let's talk a little bit-- let's go back and talk about the Men's Clinic again because I don't think people probably heard that. So tell us again about the Clinic and what the goal is there.

Well, thank you again. This is great again. And I'm glad that we can-- promoting this because this is, in June, actually, going to be, coming up, the Men's Health Month in United States. So it coincided nicely with the opening of our clinic.

The Men's Health Wellness Program at University of Chicago is going to be one of the really state-of-the-art clinic program whereby we are not only going to provide expertise on urology, men's health, sexual dysfunction problems. But also, we're going to link our men to multiple specialties, looking at their men's wellness in general.

For example, if they have cardiology problems or heart issues or even they have diabetes or weight issues-- linking those men with us in the clinic with multiple doctors, be able to see doctors at once, providing their high-level consultation to those men. So really, very proud, very excited about this program. It's going to provide really cutting-edge services and consultation to our men in Chicagoland.

So we're going to play a couple of soundbites here in a few minutes with one of the patients of-- one of your early patients of the Clinic. And it's interesting because this is an area that, I think, for a lot of men, it's a difficult conversation to have. And I think a lot of men-- they'll received treatment for something, particularly when we're talking about ED and incontinence. And some people just figure, well, this is what I've got to live with for the rest of my life.

That's not necessarily the case. And that's why this is so important, I think, to have this discussion. And I don't know how to do it. But it would be nice to be able to kind of dispel some of those fears around talking about this. And I don't know if either one of you have any thoughts on that or any comments. It's just such a touchy subject.

Absolutely. I can start first. And Dr. Faris probably will add her input as well here. But I think when it comes to erectile dysfunction, sexual dysfunction in men in general, it becomes very sensitive. Men want to speak with a provider who can actually provide them with a good consultation, give them good options for treatments, and also being able to open up this conversation.

It's a touchy subject. Men-- we know they're lagging behind women in terms when it comes to their health care. We know about five to six years' gap between women and men when it comes to health care. So I think being able to provide those safety clinics where they can open up and share their concern in an open manner-- and then the other end, we provide them with the treatment option that they deserve.

And not only that, we can able to connect those men with ED, for example, with other health providers, like, for example, cardiology or heart specialist. Because we know ED can be a check engine or a alarming sign for underlying cardiovascular problems.

I like that check engine. It's kind of like the check engine light going off. I never thought about that. But that's a great point because it can indicate other issues within the body that need to be checked out. Dr. Faris, can you tell us a little bit about, from your standpoint, just the importance and how you kind of dispel some of the awkwardness or difficulty that people have discussing this?

I think just being very open to the conversation-- and especially for me personally, when I find a patient starting to be a little embarrassed, helping along with the questions. We talk about this all day, every day. So we're very comfortable having these conversations. And really, there's not much you can say that would ever shock us. We'll put it that way.

And I think patients being reassured to know that this is-- we're very comfortable with this. We're very open. And we're here to help. I mean, that's the real reason that we're here-- is to be able to provide therapies for patients. Yeah, I think helping-- just that comfort level that we have puts patients at ease significantly.

Great. We are encouraging our viewers to type questions in, and we'll answer those. One of the questions that just came in-- does the Men's Clinic include mental health? I hadn't thought of that one. But it makes sense, I suppose.

Absolutely. I think, yes, indeed, we have partnered with our psychology department. And we have great providers who really provide high-level consultation. When it comes to mental health, important factor for men to develop ED, Erectile Dysfunction, as well as sexual dysfunction, especially the younger ones. So we do provide a virtual as well as in-person consultation when it comes to mental health as well.

Great. And I promised we would play some of these couple of soundbites from Clarence, who is a patient of yours. Let's play this second one first, John, if we can. I've got them in reverse order. I apologize.

But this one, Clarence is going to give some advice to other men who may be potentially facing similar issues. And Clarence, if I remember correctly, had an issue with-- he did have prostate cancer. He got treatment. And that led to some other issues.

I would tell him, if your MD recommends a urologist, to make sure you find a good one right away who has a plan and follow through with the testings and leads you through it. And obviously, I would strongly recommend the University of Chicago because of what I've gone through and what they've done for me.

Within a month of meeting an oncologist here, I had already seen a radiation. I'd already gone through a complete body scan and was set up to go on the medications. The doctors were calling me 6:30, 7 o'clock at night, telling me what to expect or what they wanted me to do in the next step. And everything was a go after that. I would tell--

See, to me, that is just so important-- the fact that the physicians connected with him the way you all did, the way you dealt with him and clearly made him very comfortable. And Dr. Raheem, I know that Clarence had multiple challenges. But he's very open to discussing this because he knows that it's a hard thing for men to talk about.

Absolutely. I think he was open, and he shared his experience. And just to be clear, actually, he had radiation treatment, which is another-- I think Dr. Faris mentioned surgery can cause erectile dysfunction, incontinence. But radiation therapy for prostate cancer or other pelvic cancers in the male body can actually lead to those outcomes, untoward outcomes, like ED or incontinence and other things.

So Clarence was nice enough to open up and share his experience. And you saw his testimony. He was very pleased with his care here, just to speak of the caliber of doctors who we have here, from radiation to surgeons to men's health to reconstructive urologists and other specialties. So really, I'm very glad that he came on and provided his insight in this.

And Dr. Faris, this really is a team effort. And I think that's one of the things that sets an institution like UChicago Medicine apart, maybe, from some smaller community hospitals. We really have a large team of physicians and experts that work together and that are really top in their field in these areas. And that's important.

It's incredibly important. And to be honest, it's one of the reasons I like my partners in this group so much. It's an incredibly collegial work group. And we help each other out. We discuss patients. We refer them to each other. If we're able to, if it's relevant for that surgeon that day, if they're in clinic, we will actually sometimes pull each other into a patient's room. And then, as I mentioned the oncology piece there, they have a well-oiled machine where it's incredibly great uro-onc group. So I think we're very blessed.

I get messages from medical oncologists about patients who are having issues. Say, after radiation, they may have urgency, frequency, urge incontinence, or hematuria, whatever it is. And they reach out for, how can we help? Can we get them in? Or the radiation specialists is the same thing. So I think the communication here is really top-notch and really enables us to do phenomenal patient care.

We have a couple more questions from viewers that I want to get to. First one-- are there conditions that impact men at different stages throughout their lives apart from urological issues? For example, should men in their 20s or 30s begin regular checkups at a men's clinic? I don't know who wants to take that one.

I can take it. The answer is yes. There are some linkage between cardiovascular disease, heart conditions, and ED. So if you are young and have ED that's not responding to medical therapy, I think my advice is to seek medical advice from your doctor or seeing us as urologists because this, as I mentioned, could be a check engine sign that you may have underlying cardiovascular problems, lipid issues, diabetes, weight management problems.

And we know that ED can proceed any major cardiac event by about two or three years. So seeing us, getting plugged into the medical system, connecting with cardiology or even the primary doctor is essential, critical for your health overall.

All right.

I want to-- sorry, just to tag along to that, I think that's one of the beauties of this Men's Health Center-- is the fact that it's all interrelated. Erectile dysfunction-- most of the time, we're going to see it not just as a side effect of treatments. But we're also going to see it organically. That's most of the time.

And so having the cardiologists involved, the endocrinologists involved, checking the testosterone, following through on all of that, diet, weight loss, all of this is-- and actually, the mental health piece of it as well is an incredibly important piece of-- I call it stage fright or, a lot of people say, getting back in the game, helping people to get that confidence again and feeling that they do have the confidence to go forward and maybe even be able to come off of any of the medications that we need. And I think that Dr. Raheem building this men's health center is really going to be very helpful for patients.

And it's interesting. That's a great point that you make as far as just having the ability to talk to the patient and put them at ease because I was reading something. I mentioned this in our preshow meeting a few days ago. I was reading something a couple of weeks ago. And there was an interesting study that said that men talk to their primary care physicians about things specific to men's health, like, for example, testicular cancer or self-exams, far, far less than women do.

And I think with men, it's like 10% or something like that. It's a very low number. In women, it's substantially higher. So it's a thought process that we've got to kind of get in our heads, I guess. We're not doing a great job of it. I'm talking about men.

Absolutely. Yeah, no, you're 100% right. I think women are much more comfortable discussing health issues. We start seeing a gynecologist regularly starting at 18. So I think there's a certain degree of it's built into what we're expected to do with regular health exams and self-checks, as opposed to men, where-- I don't know how many of your patients. But a lot of them won't have seen a doctor, and they're like 50 years old. And so I think that starting those regular exams and knowing that it's actually really important just to the preventative health and taking care of yourself is a really big piece of all of this.

Dr. Raheem, I'd be really curious. I wonder how many men out there have a yearly physical exam. I would guess the percentage is pretty low.

It's very low.

[LAUGHING]

And I think Dr. Faris is absolutely right. I think we're lagging, men lagging behind. It's our job as health providers to really promote that. As I mentioned, Men's Health Month coming up in June. I think this is a great opportunity for us to promote more PSA checks, self-examination for testes cancer, low testosterone, ED awareness, among others.

So again, I think this is going to be a great-- I think important to have a checklist to screen all these things. And it can be done by urologists, like myself or Dr. Faris, or by a primary doctor-- checking for things that are very common, lipid issues, heart problems, PSA check when you are at the age of screening, and so forth.

You know-- go right ahead.

Oh, I was going to say, don't you think it's so important how-- so many of our patients will come in-- so the lag for treating incontinence is like five to seven years. And they come in, and they're like, I didn't even realize that there were options for this, whether or not they're so embarrassed to speak up or mention or whatever it is. And it's the same thing with erectile dysfunction. It's that embarrassment and not speaking up.

And I think it's so important for patients to know that we're here. And this is what we enjoy doing. And we're here to help you and to not be embarrassed because there's so many treatments we can actually offer and get things moving along and get your life back.

So I just want to mention, really, also the females and the partners of the men also has a huge role of this. Dr. Faris just reminded me. But many of us, we tell them to come into the offices and get checked and all these things. So great for them. But also, the women and partners and the wives and girlfriends need to push for that as well to help men get back into the system.

If you have problems, if you recognize a problem at home, please bring your partner to see us. And we'll be happy to. And that's also include also male fertility section, which is-- I know the focus of this is men's health. But I think male fertility-- it's also a huge part of reproductive health in men. So for those men who suffer from cancer, please seek help.

So you guys set me up pretty well for a good segue to the sound bite number one with Clarence, where he talks a little bit about his experience in the clinic and how comfortable everybody made him feel.

So I talked to Dr. Golden down there. And he referred me to Dr. Raheem. And I went down to the University and met with him.

Yes, he's very personal. And he's got that invitation-type personality where he makes you feel good being there and helps you through and bringing things out whereby you're nervous. And you're a little afraid to discuss this stuff. But I basically think he's a wonderful doctor and definitely stays on top of it.

So again, it's a difficult situation a lot of times, I think, for men to deal with stuff like this. And I get it. But you all are very well-versed in making people feel comfortable on at home, which is important.

So can you talk to us-- you mentioned low testosterone earlier. And I'm kind of curious about that one because we hear the radio commercials all the time to take this drug or that drug. And you go pick them up at your big-box store. And I always kind of shudder when I hear that because I doubt the value of that. But I could be wrong. Can you talk to us a little bit more about that and what can be done?

So I'll take this.

[LAUGHING]

Sorry about that. I kind of set you up, didn't I?

No, it's OK. It's OK. No, absolutely. We specialize in as well at the men's health program here. So low testosterone is very common. It affects the whole spectrum of men.

There are multiple reasons why men get low testosterone-- diabetes, obesity, undergoing treatment for cancer with androgen deprivation therapy. And so there's a lot of factors can lead to low testosterone. And the signs are very common. You feel tired, overweight, lack of libido, sex drive, and ED, among other things. Weight gain is another thing.

So when you have these symptoms, I think you should get blood checked, testosterone levels done in the morning. And then there are options out there, starting from lifestyle changes to diet modifications to, really, medications. And now we have a whole spectrum of testosterone replacement therapy. We give it to improve those symptoms.

Great. So we do have a couple more questions from viewers I want to get to. This one-- my father was recently diagnosed with stage one prostate cancer. I'm 34. Are there some general things I should start thinking about for my own risk? I don't know who wants to take that one.

Yeah. So with a family history of prostate cancer, we generally recommend starting to screen a little bit younger, essentially-- so starting to see your primary care doctor or urologist probably closer to 50. I'm guessing his dad is older than 50 if he's 35. But some of it is also based on the age that your parent was diagnosed. So if his father was actually diagnosed at 50, we may want to start screening it at like 35 or 40 and moving that up.

And that's a pretty simple screening, isn't it?

Yeah. It's a blood test to check the PSA and a rectal exam to check for any lumps or bumps in the prostate.

Another question from a viewer-- why should someone schedule with a men's clinic versus just their regular primary care doctor?

Great question, and I'm glad he asked this question. I think what separate us apart from other clinics around Chicago area is that we are-- make no mistake. Most patients will want to go to the greatest and latest hospitals in the area.

But at the University of Chicago, we're not only providing this latest and greatest technology. But also, we are connecting you as a person, as a patient to highly qualified, specialized group of doctors that provide consultation not only about ED, but also about other things that can be connected, like, for example, cardiovascular risk I talked about earlier or diabetes, which is huge, or even weight problems.

So we are able to connect you rather quickly to those doctors and getting access to those under one roof and the one clinic called the Men's Wellness Clinic and secure those appointments quickly without having to go through referral systems. And we're able to that virtually. So you see the access is provided rather rapidly, seeing all the specialized under one roof.

Great. So let's talk about today's treatment options but, more importantly, some of the new treatments that are coming because I think there are some exciting things that are happening. And I'll open that question up to both of you. I don't know who would like to start.

Treatments for--

Well, ED or incontinence does seem to be kind of the-- go right ahead.

I'll start more simply with the incontinence because the ED piece of it gets much longer, I think. For the incontinence, just on a very basic level, there are generally two different types of incontinence. So there's actually an urge urinary incontinence, which is where the bladder is squeezing when it's not supposed to. And it can squeeze hard enough where you leak. And then there's a stress urinary incontinence, which is the type that we see from the lack of the support holding things with coughing, sneezing, laughing.

For the urge urinary incontinence we're looking at, we usually start-- kind of pathway. But we usually start with medications. And then if we tried like one or two, if that doesn't work, we do some special testing. And there are things, actually, like Botox in the bladder or sacral neuromodulation, which is kind of like a pacemaker for the bladder that stimulates the nerve going to the bladder. It's surgically implanted.

For the stress urinary incontinence, generally, we start with pelvic floor physical therapy to really work on strengthening those muscles and also teaching men how to use those muscles. Because as I mentioned, most men have never had to use them before.

And then, if that doesn't work, then we start to think about things like slings, which is a support for the urethra, or something called an artificial urinary sphincter, which is an implantable device that goes around the urethra and is gently closed around it to provide that resistance. And then there's actually a pump that we put-- everything is on the inside-- a pump that we put in the scrotum where you press it. And it opens up that valve to allow you to go to the bathroom. And it's actually remarkably discreet once you start to learn how to use it. I think most men just use a urinal, and people don't even notice.

Interesting. I didn't know that existed. That's interesting.

Yeah.

So Dr. Raheem, what are some of the things we're looking towards in the future?

Well, it's a lot I can tell you, Tim. Again, one of the exciting things at the University of Chicago is linking the conditions the men will have with research and trials. So we are really at the forefront with when it comes to erectile dysfunction research and trials.

So one of the things we're excited about is providing the latest technology in terms of treating ED. We know about the drugs, the pills, and the injections that could help men. But also, we have surgical techniques we can provide with a prosthesis to help restore erectile function even more better for those men who really have severe type of ED, Erectile Dysfunction.

But also, we're now in the process of getting the newest treatments which is in the context of trials and research trials, like the shockwave treatments and the stem cell work and the plasma-rich platelet treatment for erectile dysfunction. Work in some progress, but I think soon, hopefully, be able to provide those to our men in Chicago, especially in the downtown area and beyond, to be able to come into our clinics and getting those treatments more readily under our supervision.

You know--

And I'm going to do-- sorry-- a little shameless plug. We also have a trial that we're-- the PI site for penile prosthesis-- actually trying to look at-- because one of the complications that is what we consider one of the dreaded complications are infections. And we're trying to figure out the role of antibiotics in that and looking at all these different aspects of the implant procedure and what might be contributing to them and which patients would benefit from different antibiotics afterwards or not and different medications.

That's one of the things that I always tell people. Big benefit to coming to an institution like ours is that we are an academic medical center. We're a research institution. So a lot of the things that we're doing are happening here before they happen anywhere else. And so you really do get that cutting-edge treatment, I guess you could say, for want of a better phrase, when you come here.

Another question from a viewer-- we're about out of time, but I want to get to this one. Is there any value to natural or homeopathic treatments for ED?

That's a great question. And I get asked a lot in my clinic routinely. Truly, there are a lot of natural stuff you can try to improve erectile function. And unfortunately, there's no robust data to support using of such a homeopathic or, let's say, supplemental medicine to help with erectile dysfunction.

Our views on this is that you can try it. There's no harm. Typically, they're very safe to take. So there's definitely no downside of taking it. But if you do take it and then not respond to those type of supplements, then you probably need to see a specialist, a urologist like myself or Dr. Faris, to evaluate you for this underlying problem that I talked about. That could be needing more medication or even procedures to help you with that.

We're about out of time. But I do have to ask you this question, Dr. Raheem, because this was an interesting study that you're involved in about marijuana and its impact on fertility and sexual health. We can probably do a whole half hour on that or an hour. But I'm curious what you've found so far and what your thoughts are in that area.

Well, thank you again. It actually came online today, I believe, the article. So really, we know that marijuana has been increasing-- increased use in the United States, for recreational and also medicinal use. The genesis of this work was when I was in Seattle. There was a fellow who really looked at the effect of marijuana on the fertility side. But we know there's a lot of effects on the sexual side as well.

The data, I have to say-- it's mixed in terms of effect of this. The study showed that men who took marijuana, whether it's past or recent, the effect-- there was a negative effect on the sperm morphology or shape of sperm or even the movement that can impact the long-term effect for fertility for men. So the advice would be or the conclusion of the paper is that if you're conceiving or trying to conceive, try to get off the marijuana because there's a negative impact if you're taking it on your sperm quality and fertility potential.

Interesting. Well, we learned all kinds of new things today. You two are great. Thank you very much.

Thank you.

We are out of time. We want to thank our guests for being with us today and want to thank you who watched and participated in the program, asking those fantastic questions. Please remember to check out our Facebook page for a schedule of programs coming up in the future.

To make an appointment, go online to uchicagomedicine.org talk. Or you can call 888-824-0200. And you need to try out that new men's health clinic or Men's Wellness Clinic. It's really a neat thing that you all are doing. Thanks again for being with us today and hope everyone has a great weekend.