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Can you tell if someone has an STD?

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How To Tell If Your Partner Has an STD.

A sexually transmitted disease (STD), also known as a sexually transmitted infection (STI), can be passed through vaginal, oral, or anal sex. Anyone who has sex can be exposed to and become infected with an STI.

Using a condom from start to finish during any type of sex (i.e., vaginal, oral, or anal) can help reduce your risk of getting an STI, but even condoms are not 100% effective.

The best way to know if your sexual partner has an STI is for them to get tested. Although STIs can cause symptoms, sometimes an individual may be asymptomatic, meaning that they can be infected with the STI without showing any signs of it. Therefore, you should never assume that someone does not have an STI simply because they do not have any symptoms.

Nevertheless, there are some telltale signs of STIs to be aware of when they do cause symptoms.

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Sores or blisters on the mouth or genitals

Sores or blisters on the genitals or mouth can be caused by herpes simplex virus (HSV), or herpes. HSV-1 is known as oral herpes, and it is spread from mouth-to-mouth contact. However, in some cases, it can also cause genital herpes through oral sex. It is important to note that HSV-1 is not always considered an STI, and it is most often transmitted through nonsexual means.

HSV-2 is genital herpes. Sometimes, HSV-2 is asymptomatic, but it can cause blisters or open sores on the genitals. As they begin to heal, the sores may become more like scabs. HSV-2 can spread from one person to another even when the sores have gone away. In contrast to HSV-1, HSV-2 is most often spread through sexual contact.

Genital warts

Genital warts can be caused by human papillomavirus (HPV), one of the most common STIs. Usually, HPV does not show any symptoms, but when it causes warts, they can show up in a few different ways.

The warts can be small and greyish or flesh colored. They can grow individually or in clusters. Though known as genital warts, they can transfer to the mouth and throat of another person through oral sex.

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Rash or signs of itching on the genitals

Itchiness near the genitals can be caused by something as innocuous as a negative reaction to a new laundry detergent, but it can also be a sign of an STI. Also, having a rash on the palms of the hands or soles of the feet might be related to syphilis.

Nonetheless, in many cases, a rash or darkening of skin in the genital region is due to fungal overgrowth (tinea cruris, or “jock itch” in men). This is probably the most common cause of genital rash and is not considered an STI.

Abnormal vaginal or penile drainage or vaginal pain with intercourse

Discharge from the vagina is normal, but if it takes on a different color, odor, or consistency, it could be a sign of infection. Gonorrhea, chlamydia, and trichomoniasis can all cause abnormal discharge from the vagina or penis.

Additionally, vaginal pain during sex can be the result of many different conditions or circumstances. Still, any new onset vaginal pain during intercourse could be related to an STI.

Infections of the throat

Of course, many diseases can cause sore throats, not just STIs. However, if a person has swollen glands, sores in their mouth or throat, or a visible fungal infection in their mouth, these could be signs of an STI. Chlamydia, gonorrhea, herpes, HPV, and syphilis can all affect the mouth and throat.

Ongoing flu-like symptoms

Flu symptoms such as fever, chills, sore throat, and body aches that persist could be a sign of an underlying STI like chlamydia, gonorrhea, syphilis, or HIV. If you or a partner have symptoms like this that last a long time, it is important to see a health care provider.

STD's - Conclusion

Again, the symptoms described above may not always appear when a person has an STI. The best way to take care of your sexual health is by practicing safe sex and getting tested for STIs when you have a new sexual partner.

There are also preventative measures such as vaccines and medications available to reduce a person’s risk of becoming infected with certain STIs, and almost all STIs are curable, with the exception of herpes and HIV.

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References

Ducre, K. Medically reviewed by William Terranova, MD on September 5, 2022. (2020, September 4). How To Tell If Someone Has an STD. https://www.stdcheck.com/blog/how-to-tell-if-someone-has-an-std/

Mayo Clinic. (2022, May 5). Sexually transmitted disease (STD) symptoms. https://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/in-depth/std-symptoms/art-20047081

Low Testosterone and Covid-19

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Low Testosterone and Covid

Does low testosterone increase your chances of hospitalization from Covid?

Low testosterone can have several negative effects on male sexual function and performance – as well as many other aspects of male health.

But new research shows that low testosterone in men might also increase your chances of ending up in the hospital if you have Covid-19.

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Low-T and Covid.

According to a recent retrospective cohort study, low testosterone levels in men may increase their risk of hospitalization for COVID-19. Conversely, normal testosterone levels in men, (whether due to the body’s natural production of testosterone or testosterone therapy,) may be protective against severe cases of COVID-19.

Male hypogonadism is a medical condition in which the gonads (i.e., the testes in men) do not produce enough testosterone, which leads to low levels of testosterone and symptoms such as fatigue, erectile dysfunction (ED), decreased sex drive, and changes in mood.

Eugonadism, on the other hand, is the term used to refer to those with healthily functioning gonads. For this study, hypogonadism was defined as a total testosterone concentration below 175 to 300 ng/dL.   

The study involved 723 men: 116 men with hypogonadism, 427 men with eugonadism, and 180 men who were receiving testosterone therapy. All of the men included in the analysis were diagnosed with COVID-19, and the average age of the men was 55 years old.

Of the hypogonadal men, 45% were hospitalized with COVID-19. This percentage was much higher than that of the eugonadal men, of whom just 12% were hospitalized with COVID-19. For the sake of comparison, the median testosterone level for the men with hypogonadism was 131 ng/dL, while the median testosterone level for the men with eugonadism was 381 ng/dL.

Interestingly, the risk of hospitalization for COVID-19 went down for the men who were receiving testosterone therapy that brought their testosterone up to normal levels. These men faced a similar risk of hospitalization for COVID-19 as the eugonadal men. Nevertheless, the men who were receiving an inadequate dose of testosterone and were still below normal levels did not see this protective benefit. They still had a higher risk of hospitalization for COVID-19 than the eugonadal men.

Although the researchers made adjustments for potentially cofounding variables such as age, race, ethnicity, body mass index (BMI), immunosuppression, and comorbid conditions, there were still some key differences between the groups of men. In general, the hypogonadal men were older, more likely to have diabetes or another comorbid condition, more likely to have a higher BMI, and more immunosuppressed than the eugonadal men.

These findings suggest that low testosterone may be a risk factor for hospitalization due to COVID-19, perhaps contributing to a decreased ability to recover from such an illness. However, it is too soon to say whether testosterone therapy should be used as a preventative treatment option to guard against severe COVID-19. Therefore, future studies should explore using testosterone therapy as a prevention strategy for hospitalization from this illness.

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References

Dhindsa, S., Champion, C., Deol, E., Lui, M., Campbell, R., Newman, J., Yeggalam, A., Nadella, S., Ahir, V., Shrestha, E., Kannampallil, T., & Diwan, A. (2022). Association of Male Hypogonadism With Risk of Hospitalization for COVID-19. JAMA network open, 5(9), e2229747-e2229747. DOI: 10.1001/jamanetworkopen.2022.29747

Monaco, K. (2022, September 2). Low Testosterone Linked to Hospitalization for COVID. Medpage Today. https://www.medpagetoday.com/infectiousdisease/covid19/100520

Peyronie’s Disease in Men

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Peyronie's Disease

What is Peyronie's?

Peyronie’s Disease is a condition resulting from scar tissue formation on the penis. The scar, which is often referred to as a “plaque,” develops on the sheath surrounding the vascular erectile tissue within the penile shaft. This may result in changes to the shape of the penis such as bending/curvature, narrowing, and penile shortening. Sometimes these changes are relatively minor, but other instances they can be quite severe. Men will sometimes experience more difficulty achieving or maintaining a firm erection as well.

It is important to emphasize that Peyronie’s Disease is a benign medical condition – meaning it is not cancerous. It will not impact your overall health, but for many men with Peyronie’s Disease it can be a source of significant distress.

Peyronie’s Disease is actually more common than you might imagine. Typically, PD is diagnosed in middle-aged men, though it can occur in men of any age, from adolescence onward. Although it tends to occur most frequently in Caucasians, men of any ethnic group may develop PD.

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Symptoms of Peyronie's Disease

Peyronie’s Disease may present with a number of different symptoms. Some men with Peyronie’s Disease experience pain in the penis with or even without an erection. This is most common with the initial stages, and the pain tends to improve and resolve over time. The plaque (scar) can be felt as a hardened area or “nodule” along the shaft of the penis. This may cause changes to the shape of the penis such as curvature or bending in the direction of the scar. There may be narrowing of the penis, and if the plaque extends around the entire penis, it may cause the penis to take on an hourglass shape. Many men also report shortening of the penis, as well as changes in the hardness of their erections. Taken together, these symptoms often make it difficult for men and their partners to participate in satisfactory sexual activity. This can create a sense of hopelessness and may lead to emotional distress.

Usually, Peyronie’s Disease happens in two stages. In the first stage (the acute phase), which may last 3-12 months or more, the plaques start to form and the penis starts to curve, narrow, or shorten. A man in this stage is more likely to have pain. In the second stage (the chronic phase), the plaque and curvature start to stabilize, but the penis usually doesn’t straighten. Pain may start to subside, but erectile dysfunction may continue or get worse.

Effects of Peyronie's

Psychological Factors
It’s not easy to have Peyronie’s disease. Men with a curved penis feel a variety of emotions: anger, sadness, shame, and anxiety, just to name a few. Often, these feelings are intertwined. Let’s take a look at some of them.

Anger and Frustration
Like many illnesses, Peyronie’s disease can change a man’s life. It affects his manhood – that physical part of him that defines his masculinity. So it’s not surprising that some men with a curved penis may feel anger. They may wonder, “Why does this have to happen to me? Why can other men enjoy sex when I can’t?”

A bent penis can also lead to frustration – with the pain, with the potential inability to have intercourse, and with any relationship problems that may result. Some men get frustrated if their doctor isn’t responsive to their needs. Or, they get frustrated because they don’t know how to broach the subject with a doctor or partner.

Fear and Anxiety
Some men fear the unknown of Peyronie’s disease. Will they still be able to have erections and orgasms like they used to? Will sexual activity make the problem worse? Will the pain subside? Will their penis ever straighten? Will they ever get 100% better? Will their current partner, or future partners, find them unattractive or reject them? Will they be able to enjoy sex again?

Satisfying a partner is another great concern. Will the partner still be able to reach orgasm if intercourse isn’t possible? Will he or she be understanding and patient about the situation?

Sadness and Loss
It’s not uncommon for men with Peyronie’s disease to mourn what used to be. Intimacy with their partner may have changed and they miss that exciting connection. They may see a happy, flirting couple at the mall or an intense sex scene in a movie and grieve the loss of these aspects of their own life.

Shame, Embarrassment, and Low Self-Esteem
As we mentioned earlier, some men with Peyronie’s disease feel that their manhood or virility has been lost or damaged. They may feel like less of a person and ashamed if they can’t perform the way they used to. They may also feel embarrassed by the appearance of their bent penis, especially if they are starting a new relationship and worry that their partner will be turned off.

Gay men may be especially vulnerable, as they might feel even more self-conscious about a curved penis when a partner has no problems with Peyronie’s disease.

Isolation and Avoidance
Often, men with Peyronie’s disease and their partners separate emotionally from one another. They may not know how to talk about their situation and, therefore avoid it, making them feel more alone.

Dating and finding new sexual partners may be daunting for single men with Peyronie’s disease. Fear of seeming inadequate and embarrassment over their physical appearance can make men reluctant to start new relationships, causing them to isolate themselves even more.

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Causes of Peyronie's Disease

Much is still unknown about the causes of Peyronie’s Disease. Research suggests it is a disorder of wound healing that occurs after some type of trauma to the penis. The classic example would be that of a patient who experiences a “misthrust” during sexual intercourse, where the penis slips out of the vagina and hits the partner’s pubic bone or perineum causing a bending of the penis. However, most men who develop Peyronie’s Disease do not recall any type of significant trauma like this. Instead, it is likely that most men experience some mild trauma (we call this “microtrauma”) to the penis during sexual activity. This goes unnoticed, but, in some cases, it may still trigger scar tissue formation.

Normally, wounds heal in three phases: First, enzymes clean the wound of dead or damaged tissue. Second, the body repairs the wound by forming a scar that strengthens the injured tissue. Finally, the collagen fibers that make up the scar are broken down and realigned leaving a smaller “remodeled” scar. In Peyronie’s Disease, not only is scar formation more “extreme,” but scar remodeling either fails to occur or is insufficient.

The abnormal scarring of Peyronie’s Disease is believed to be related to the processes that occur at the cellular level which stimulate the formation of scar tissue in the second phase of wound healing. During this process, excessive amounts of collagen, which is a type of protein, accumulate to create a plaque. Enzymes that normally regulate collagen production, and are responsible for remodeling scar tissue in the third phase of wound healing, may also play a role. Patients with Peyronie’s may produce too few of these enzymes or the enzymes they produce may not function properly to remodel the scar. To further complicate matters, in some men, part of the collagen in the plaque may be replaced by calcium.

Peyronie's - Treatment

Peyronie’s Disease is a benign, or non-cancerous, condition. This means that, if the symptoms are relatively mild or do not bother you, it is OK to simply observe. There have only been a few studies that have looked at what happens to men over time who decide not to pursue treatment during the first year or so after their symptoms start. One of the original studies from the 1970’s suggested that as many as half of all men with Peyronie’s Disease would see improvement with observation alone. Unfortunately, we now know that only about 5-15% of will actually see spontaneous symptom improvements. In contrast, up to half of men with Peyronie’s may see some worsening of their symptoms (particularly curvature and shortening of the penis) over the first year. Thankfully, things will eventually stabilize and, nearly always, the pain (if present) will get better or completely go away.

For those men who want to pursue treatment, it is important for the treating clinician to discuss the goals of treatment. Goals may include preventing things from getting worse, improving curvature, recovering some penile length, resolving pain, and ultimately making it easier to participate in sexual activity. It is usually not possible to restore the penis to what it was before the Peyronie’s Disease started. Each individual will have his own set of goals, and there is not a single right treatment for everyone.

Pills
Researchers have studied a number of oral therapies for PD, including: carnitine, colchicine, potassium aminobenzoate, tamoxifen, pentoxifylline, and vitamin E. These oral agents have been evaluated because of anti-oxidant or other properties which are thought to interfere with collagen synthesis and scar formation.

Unfortunately, most studies using oral PD therapies haven’t been well controlled. Since some PD cases improve on their own, and few studies of oral medication have compared treated patients to an untreated “control group,” it’s not clear if the oral therapies for PD offer any benefit over no treatment at all in terms of penile curvature, pain, or the ability to have intercourse.

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The P-Shot for Erectile Dysfunction

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What is the "P-Shot"?

The P-Shot, also known as a platelet-rich plasma (PRP) injection, is being tested as an experimental therapy for erectile dysfunction (ED).

It involves taking a sample of the patient’s blood, using a centrifuge to separate out the PRP from the other components of blood (i.e., red blood cells and platelet-poor plasma), and injecting the PRP into the penis to promote the growth of penile tissues.

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How does the P-Shot work?

In theory, the PRP would act as an agent to repair damaged tissues in the penis, leading to better erections. According to some, the P-shot can improve blood flow to the penis, create stronger erections, improve sensation and performance, and even increase penile length and girth.

Despite numerous claims of its efficacy, PRP remains a hotly debated topic of discussion in the field of sexual medicine.

Currently, there is a very limited number of peer-reviewed studies that have tested the safety and effectiveness of PRP in treating ED in humans.

The P-Shot. Results in rats

A few studies have published results that show improvements in the erectile function of rats with the use of PRP. While encouraging, these findings cannot be applied to humans, which is why it is so important to have controlled human studies that replicate these results.

One study aimed to do so by testing the effectiveness of PRP in treating urologic conditions in 17 different patients, including four patients with ED and one patient with both ED and Peyronie’s disease (PD). On average, the patients received 2.1 PRP injections for their condition(s). The injections were well tolerated by the patients overall, and the only reported side effects were mild pain at the site of injection (3 out of the 17 patients) and slight bruising in the area (1 patient). 

None of the ED and/or PD patients in this study experienced worse erectile function after receiving PRP injections, as measured by the International Index of Erectile Function (IIEF-5). The IIEF-5 scores of the patients increased an average of 4.14 points after PRP therapy. However, since the patients were being treated for different conditions, did not receive the same number of injections, and were not compared to a control group, the researchers were unable to draw definitive conclusions about the effectiveness of PRP in treating ED.

The first double-blind, randomized, placebo-controlled trial to evaluate the efficacy of PRP therapy in treating ED was published in May 2021. For this study, a group of 60 sexually active patients with mild to moderate ED were randomly assigned to one of two groups: the PRP therapy group or the control group. Both groups received two intracavernosal injections spaced one month apart, but the 30 men in the PRP group received PRP injections, and the 30 men in the control group received placebo injections.

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The P-Shot: Conclusion

The participants’ erectile function was assessed at baseline and at 1, 3, and 6 months after their final treatment using the IIEF – Erectile Function Domain. More than half (69%) of the men in the PRP group achieved a minimal clinically important difference (MCID) in their IIEF scores at the 6-month mark, compared to 27% of the men in the control group. No adverse side effects were reported, and the men in the PRP group were more satisfied with their treatment. While these results are positive, the authors point out that the extent of the improvement was limited, and it remains unclear whether PRP therapy results in long-term improvement. 

These studies and others like them provide a good starting point, but more research needs to be done to determine whether PRP could be a safe and effective treatment option for ED.

In a statement on restorative therapies for ED, the Sexual Medicine Society of North America (SMSNA) acknowledged that PRP might be effective for regenerating erectile tissues, but at this point, there is simply not enough evidence to recommend it as a medical treatment.

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References

Krzastek, S.C., Bopp, J., Smith, R.P., & Kovac, J.R. (2019). Recent advances in the understanding and management of erectile dysfunction. F1000Research, 8. DOI: 10.12688/f1000research.16576.1

Liu, J.L., Chu, K.Y., Gabrielson, A.T., Wang, R., Trost, L., Broderick, G., Davies, K., Brock, G., Mulhall, J., Ramasamy, R., & Bivalacqua, T.J. (2021). Restorative therapies for erectile dysfunction: position statement from the Sexual Medicine Society of North America (SMSNA). Sexual medicine, 9(3), 100343. DOI: https://doi.org/10.1016/j.esxm.2021.100343

Matz, E.L., Pearlman, A.M., & Terlecki, R.P. (2018). Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Investigative and clinical urology, 59(1), 61-65. DOI: https://doi.org/10.4111/icu.2018.59.1.61

Poulios, E., Mykoniatis, I., Pyrgidis, N., Zilotis, F., Kapoteli, P., Kotsiris, D., Kalyvianakis, D., & Hatzichristou, D. (2021). Platelet-rich plasma (PRP) improves erectile function: a double-blind, randomized, placebo-controlled clinical trial. The journal of sexual medicine, 18(5), 926-935. DOI: 10.1016/j.jsxm.2021.03.008

Scott, S., Roberts, M., & Chung, E. (2019). Platelet-rich plasma and treatment of erectile dysfunction: critical review of literature and global trends in platelet-rich plasma clinics. Sexual medicine reviews, 7(2), 306-312. DOI: https://doi.org/10.1016/j.sxmr.2018.12.006

Wu, C.C., Wu, Y.N., Ho, H.O., Chen, K.C., Sheu, M.T., & Chiang, H.S. (2012). The neuroprotective effect of platelet‐rich plasma on erectile function in bilateral cavernous nerve injury rat model. The journal of sexual medicine, 9(11), 2838-2848. DOI: https://doi.org/10.1111/j.1743-6109.2012.02881.x

Can Vitamins Affect Male Sexual Performance

by

Can Vitamins Improve Male Sexual Function

Vitamins for Male Sexual Health

Can Vitamins Improve Sexual Function?

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Research of Vitamins is Limited

Currently, the research on the effects of vitamins and vitamin deficiencies on sexual health is very limited. Nevertheless, given that vitamins are organic compounds that are essential for normal growth and for regulating bodily functions, it makes sense that a person’s vitamin levels could affect their sexual functioning as well. The following is what is known thus far about vitamins and their potential impact on sexual function.

Vitamin D

Vitamin D, which can be produced through sun exposure and is found in fatty fish and fortified milk, is perhaps the most highly researched vitamin in terms of sexual health. In men, vitamin D appears to support testosterone production and healthy endothelial function. (The endothelium is a thin layer of cells inside the heart and the blood vessels that is necessary for relaxing and contracting the blood vessels, controlling blood clots, and helping with the body’s immune response).

Researchers have found that vitamin D helps stimulate nitric oxide and antioxidants in the endothelium which reduces inflammatory diseases that can hurt a person’s vascular function. This, in turn, may improve vascular function, which is very important for erectile function.

Past studies have found correlations between healthy levels of vitamin D and improved male sexual function. One such study found that men with vitamin D deficiency had significantly lower International Index of Erectile Function (IIEF) scores than the men in the control group.

For women, vitamin D has been shown to help with the secretion of estrogen and the maturation of vaginal cells. Estrogen is a key hormone when it comes to female sexual function as it helps support healthy vaginal tissues and good lubrication, which makes sex more comfortable and enjoyable for women. In fact, intravaginal vitamin D suppositories have shown positive results in improving painful sex and vaginal atrophy symptoms in postmenopausal women when compared to a placebo.

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Vitamin C

Similar to vitamin D, vitamin C has been shown to be protective against endothelial dysfunction. Vitamin C is a powerful antioxidant that helps with nitric oxide availability, which supports the endothelial and vascular function that crucial for good sexual functioning. This vitamin is found in citrus fruits such as oranges, lemons, and tomatoes.

Vitamin E

In animal studies, vitamin E levels appear to be associated with Leydig cells, which are the main source of testosterone in males.

Animals with vitamin E deficiency had a lower number of Leydig cells, lower testicular weights, and more testicular damage than healthy animals. While it appears that vitamin E may be helpful for testosterone production and, consequently, sexual functioning, it is important to determine if these findings translate to humans as well.

Vitamin E is found in nuts, seeds, avocados, mangos, and plant-based oils.

Vitamin B9 (Folate)

Folate is found in beans, peanuts, whole grains, and dark leafy vegetables. Like other vitamins, it contributes to healthy endothelial function. Additionally, it is very important for metabolizing serotonin, which plays a major role in regulating ejaculation.

A 2014 study in China found that folate deficiency was associated with erectile dysfunction and premature ejaculation in men. However, further research needs to be done to see how this vitamin may impact sexual functioning of humans across the board.

Vitamins for Sex - Conclusion

Vitamins may help support healthy sexual functioning, but sexual health is comprised of many different components including neurological processes, vascular function, mental health, and even relationship dynamics.

Therefore, one should not expect that any sexual health issue can be solved by taking a multivitamin. Still, these findings suggest that there may be a sexual health benefit to eating a healthy, balanced diet and taking supplements to address any vitamin deficiencies you may have.

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References

Ali, M., Smith, R.P., & Ortiz, N.M. (2022). The Impact of Vitamin Deficiencies on Sexual Health. The Journal of Sexual Medicine, 19(9), 1313-1316. DOI: https://doi.org/10.1016/j.jsxm.2022.06.013

Crafa, A., Cannarella, R., Condorelli, R.A., La Vignera, S., & Calogero, A.E. (2020). Is there an association between vitamin D deficiency and erectile dysfunction? A systematic review and meta-analysis. Nutrients, 12(5), 1411. DOI: https://doi.org/10.3390/nu12051411

Yan, W.J., Yu, N., Yin, T.L., Zou, Y.J., & Yang, J. (2014). A new potential risk factor in patients with erectile dysfunction and premature ejaculation: folate deficiency. Asian Journal of Andrology, 16(6), 902. DOI: 10.4103/1008-682X.135981