Epidemiology & Strategy
National Men's Health Strategy 2020-2030
Men die more often from preventable diseases than women. The National Strategy identifies 5 priority health issues where men are over-represented:
- Mental Health (including suicide)
- Chronic Conditions
- Sexual & Reproductive Health
- Injuries and Risk Taking
- Healthy Ageing
Disorders of the Penis
Anatomy Note: The Foreskin
A non-retractable foreskin is a normal variant in children. Retractability increases with age: 10% at 1 year, 50% at 10 years, 99% at 17 years. Never forcibly retract the foreskin for cleaning.
Phimosis vs. Paraphimosis
| Condition | Description | Paramedic Implication |
|---|---|---|
| Phimosis | Pathological tightening of the foreskin preventing retraction over the glans. Can cause urine trapping and balanitis. | Not usually an emergency unless causing urinary retention. |
| Paraphimosis | Foreskin is retracted behind the glans and cannot return. Acts as a tourniquet. | Urologic Emergency. Causes swelling, pain, and potential necrosis of the glans. Requires analgesia and transport. |
Priapism
Definition: Involuntary, prolonged erection (>4 hours). Urologic emergency due to potential ischemia.
- Ischaemic (Low-flow): Painful. Caused by Sickle Cell Disease, leukemia, or drugs (ED meds, cocaine). Blood is trapped.
- Non-Ischaemic (High-flow): Not usually painful. Caused by trauma (fistula formation).
Balanitis
Definition: Inflammation of the glans penis. Often presents with pain, redness, swelling, and discharge.
Causes: Poor hygiene, chemical irritation, or fungal infection (Candida). Red Flag: Recurrent balanitis in adults may indicate poorly controlled Diabetes Mellitus.
Zipper Injuries
Common in children. The foreskin or scrotum becomes entrapped.
DO NOT attempt to unzip or remove the zipper in the pre-hospital setting. This causes excruciating pain and tissue damage.
Action: Provide analgesia, limit movement, transport for removal (often requires cutting the zip mechanism).
Disorders of the Scrotum & Testes
History Taking Sensitivity
Assessment of the male genitalia can be embarrassing for the patient. Paramedics do not typically perform physical scrotal exams in the field unless trauma/hemorrhage is present. Diagnosis relies heavily on history.
Key Questions: Onset (sudden vs gradual)? Trauma? Sexual history (STI risk)? Urinary symptoms? Nausea/Vomiting?
Testicular Torsion vs. Epididymitis
| Feature | Testicular Torsion (Emergency) | Epididymitis |
|---|---|---|
| Pathophysiology | Twisting of the spermatic cord cutting off blood supply. | Inflammation of the epididymis (usually bacterial/STI). |
| Onset | Sudden, severe pain. | Gradual onset (24-48 hrs). |
| Age Group | Common in adolescents/young adults. | Sexually active men or older men (UTI). |
| Associated Sx | Nausea and Vomiting are common. | Fever, dysuria, urethral discharge. |
| Reflexes | Absent cremasteric reflex. | Cremasteric reflex usually present. |
The TWIST Score (Clinical Prediction for Torsion)
| Clinical Feature | Points |
|---|---|
| Testicular Swelling | 2 |
| Hard Testis | 2 |
| Absent Cremasteric Reflex | 1 |
| Nausea / Vomiting | 1 |
| High Riding Testis | 1 |
| Low Risk (0-2) | No Ultrasound |
| Intermediate (3-4) | Ultrasound Warranted |
| High Risk (>5) | Urgent Surgery |
Testicular Cancer
Most common cancer in men aged 15-35. Risk factors include cryptorchidism (undescended testes). Often presents as a painless lump or slight enlargement/heaviness in the scrotum. Early detection leads to 95%+ cure rate.
Disorders of the Prostate
Anatomy
The prostate sits at the neck of the bladder. Enlargement compresses the urethra, leading to Lower Urinary Tract Symptoms (LUTS).
| Condition | Benign Prostatic Hyperplasia (BPH) | Prostate Cancer |
|---|---|---|
| Description | Non-cancerous enlargement. Extremely common (>50% of men over 60). | 1 in 6 males diagnosed by age 85. |
| Symptoms | Hesitancy, frequency, urgency, weak stream, nocturia, sensation of incomplete emptying. Can lead to Acute Urinary Retention. | Early stages: Often asymptomatic. Late stages: Similar urinary symptoms to BPH, blood in urine/semen, bone pain (metastasis). |
| Management | Catheterization for retention. Surgery (TURP). | Monitoring, surgery, radiation. |
Endocrine Issues & Androgen Abuse
Androgen Abuse (Performance Enhancing Drugs)
Approximately 2% of Australian secondary students report using image-enhancing drugs. Paramedics must recognize the systemic signs of abuse.
Physical Signs:
- Rapid/Significant weight gain (Muscle)
- Severe acne (Face/Back)
- Gynaecomastia (Breast tissue growth)
- Testicular atrophy
- Injection site infections/abscesses
- Hypertension & Abnormal ECG
Psychological Signs: Aggression ("Roid Rage"), impulsivity, anxiety, depression.
Legitimate Androgen Use
Hypogonadism (testicular failure) or pituitary disease causes androgen deficiency. These patients require testosterone replacement therapy. Be careful not to assume all muscular patients on testosterone are abusing it.