When should you be worried about bed wetting in children?

Is it a rule of thumb that with advancing age comes sexual function problems?

With advancing age, multiple changes, such as tissue ageing, hormonal alterations, and hardening of the arteries, happen to the body. This causes the reduced blood supply to the genital organs and also related comorbidities due to old age like diabetes and hypertension and their medication. All these factors can cause a reduction in sexual performance and libido.

To prevent these changes, regular exercise and a healthy lifestyle along with keeping the comorbid conditions in check help men to retain their sexual prowess.

Regular check-ups with the urologist for testosterone hormonal issues and rectifying them makes dealing with age-related decline in testosterone hormones easier.

In case of sexual weakness in spite of lifestyle changes, men need to consult a urologist to start medication like PDE-5 inhibitors to boost the blood supply and regain their sexual power.

I have been having constant urinary tract infections and after I get treatment, they recur. What could be the problem?

In men, recurrent UTIs are mostly caused by a blockage in the urinary tract because of prostate enlargement or stricture (narrowing of the urethra). So, rectifying the prostate enlargement or stricture issue can prevent further infections.

In young females, it is mostly because of the short urethra and sexually active status. The remedy would be taking simple measures like sexual hygiene. These measures could be practising local hygiene and passing urine immediately after the coitus. If these measures fail, then long-term low-dose antibiotics help most patients.

In elderly females, because of the post-menopausal state, the local tissue wastes away and dries up and this can lead to recurrent urinary tract infections. Low-dose long-term suppressive antibiotic therapy along with measures to maintain genital health by administering local hormonal ointments can help in overcoming this issue.

 What are the common causes of urinary tract infections?

In men, urinary tract infections are mostly caused by prostate enlargement in the ageing population. In women, recurrent urinary tract infections are common due to a short urethra and can happen after they start getting sexually active. In post-menopausal women, due to low female sexual hormones, urinary tract infections can happen due to ageing and drying of vaginal and urinary tract tissues.

 How does the state of my urinary tract impact my fertility?

Any urinary infections can lead to infection in the genital tracts like testicles and epididymis as the urinary and genital tract are interlinked. So a healthy urinary tract can ensure healthy fertility.

Does the removal of the prostate reduce or affect sex performance?

Many times prostate gland removal can improve the quality of life by improving the health of the urinary tract and reducing troublesome urinary issues. This can in turn improve the sexual performance. But as the prostate is the gland which works in providing the nutrition to sperms, its removal can cause disruption of the genital tract and lead to a non-ejaculation or retrograde ejaculation.

Why do you think there is an increase in prostate cancer cases in men?

The increase in prostate cancer cases in the world can be attributed to improved awareness among the healthcare providers and patients, leading to routine serum PSA test; a marker for prostate malignancy. The serum PSA test inclusion in many of the master health check programmes has resulted in detecting the prostate malignancy early.

My daughter, now 15, is still a bed wetter. Should I be concerned about a problem with her bladder function or is it normal? Can I do anything about it and how can I help her?

At 15 years bedwetting definitely needs consultation with a urologist. Most of the time the bedwetting is not because of any serious underlying pathology and can be corrected with medicine and behavioural therapy. But bedwetting persisting till adolescent age needs evaluation for any underlying urinary tract pathology.

If undescended testicles in a child are left unchecked, how can that affect their future reproductive health?

The undescended testicles can waste away if left unattended due to higher intra-abdominal temperature, changing the proper function of testicles. The undescended testes are also more prone to trauma if they are in the groin and not in their usual safe position in the scrotum.

My son got mumps at 10 and I noticed a small reduction in testicle size. Though he is well now, I worry that it may have caused infertility. Is that a valid concern? If yes, is any damage reversible?

Mumps can cause the testicles to swell (orchitis) and there is potential risk of atrophy. This is where the testicle reduces in size and function. Two-sided mumps orchitis can lead to infertility. If suspected early, there is a therapy - the interferon injection therapy that may prevent the testicular dysfunction.

My son is almost hitting puberty and I have been battling with the decision to get him circumcised. My community generally does not, but I am open to it. What are the primary consequences to his health should I make either decision?

Circumcision is a healthy practice, and if there are no religious or social restraints, it can definitely be undertaken to improve the penile health and hygiene. It has been proved that circumcision can help in preventing sexually transmitted diseases by preventing trauma during coitus.