Am I Dying

by Christopher Kelly

  The more gradual onset of pain and swelling may be caused by an infection of the epididymis, the structure that sits on top of the testicle and stores sperm. This condition, known as epididymitis, usually results from the sexually transmitted infections chlamydia or gonorrhea. (Maybe take care of that before the second date?) In older men, and in men who are tops during anal intercourse, it can result from the same bacteria that cause urinary tract infections (like E. coli). In either case, the treatment is antibiotics.

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  There is a soft lump on the top of your testicle. The top of the testicle contains a structure known as the epididymis. In addition to ruining the dreams of young children at spelling bees, the epididymis also stores sperm from the testicle in preparation for ejaculation. Sometimes a portion of the epididymis becomes enlarged for no good reason. The condition is not dangerous and only rarely requires treatment. Unfortunately, since most people cannot reliably identify the top of the testicle, and because testicular cancers can sometimes arise from the same location, you’ll need an ultrasound of your scrotum to confirm the diagnosis.

  The bump/bulge gets larger when you cough. Have you ever been asked to drop your trousers, turn your head, and cough? (If so, hopefully it was by a doctor and not a TSA agent.) This simple maneuver tests for hernias, which are loops of intestine that accidentally slip down from the abdomen into the scrotum. When you cough, your diaphragm pushes down your guts, forcing any hernias further into the scrotum. As a result, the bulge or lump becomes larger. If the hernia is frequently painful, or it can’t be temporarily pushed out of the scrotum with a finger, a surgeon should fix it. If the bulge becomes really painful, it could be twisted up and not receiving enough blood. In this case, you should head to the E.R.

  There is a firm bump anywhere on your testicle. You need an ultrasound to check for cancer. Don’t ignore the problem and just hope it will go away. Testicular cancer is highly treatable if caught early, but fatal if detected too late. The average age at diagnosis is in the early thirties, so don’t give yourself a pass just because you’re young and otherwise healthy.

  Erectile Dysfunction

  Plato once wrote that the penis is like a tomcat: hidden during the day but eager to play at night, desperate for attention but skittish around strangers, and allegedly under the control of its owner but actually just doing whatever it wants. (Just kidding, we totally made that quote up.)

  Erectile dysfunction is defined as the inability to establish or maintain an erection that is adequate for penetration. Related issues include decreased sex drive and ejaculation that doesn’t follow your plan—either occurring too early or not occurring at all. These problems often cause many men and their partners to experience shame, anxiety, and depression.

  The introduction of medications such as Viagra in 1998 was revolutionary not only because it brought about an easy fix for many men, but also because it started a new conversation about erection problems (and Bob Dole’s penis). All of a sudden, humor seemed to replace silence about these issues, and people with erectile dysfunction—newly rebranded as “ED”—realized they were in good company.

  Of course, many men out there still obsess about their erection problems—not only because they judge their manliness and self-worth by the strength of their shaft, but because they (rightfully) fear their symptoms could be a sign of serious trouble.

  So, how to deal with your dangler? Do you need to pop a pill before dessert arrives? Lure your partner into side-by-side bathtubs like on TV? Or is there a simpler solution to get your mojo back?

  Take a Chill Pill

  You can get it up, but not at the right time. So you’ve maneuvered your way through the friend zone, scored a few dates, and convincingly pulled off a line about an after-dinner drink at your place. The clothes are coming off, your heart is pounding, and as you slip off your new designer briefs . . . you’ve got a scared worm dangling between your legs. But wait—this morning, when you first woke up, you could have hung a flag from that thing! You have one of the most common causes of erectile dysfunction . . . straight up performance anxiety. It happens to almost everyone. The risk, in this case, is entering the death spiral of dread, in which one failed sexual attempt leads to anxiety during the next rendezvous, which leads to another failure, and so on. You must find your Zen place and break the cycle. Masturbate to prove to yourself that the plumbing still works. Work your way back up to regular intercourse with some lower-stakes foreplay. Like everyone who faces this issue, you’ll be back to normal soon.

  You’re a smokestack. Among men in their twenties and thirties, cigarette smoking is a leading cause of erectile problems. Nicotine can damage the blood vessels in your penis (along with everywhere else in your body), leading to difficulty getting it up. Next time you see a cigarette, think of your penis: it may look firm and long at first, but if you light up it’s going to shrivel and wither. Fortunately, if you kick the habit, your penis will probably return to normal.

  You’re training to win the next Tour de France. Though great for the heart, cycling can put uncomfortable pressure on the nerves in the perineum (that little space between your penis and anus), resulting in numbness and erectile dysfunction. You only get to invoke this as an explanation if you’re spending a few hours on that firm rubber seat each day. Try a softer or wider seat. We’ll also assume that, unlike Lance, you aren’t using anabolic steroids (which can also cause erectile dysfunction). If your symptoms don’t improve after a few weeks off the seat, drive (don’t bike) to your doctor.

  You’re trying (and failing) to be the next Hugh Hefner. Not quite the salt-and-pepper stallion you hoped to be? As you get older, it’s very common to experience some loss of libido (sex drive) and occasional erectile dysfunction. By age forty, about 40 percent of men experience some problems with erections. If you’re over fifty but striving for the all-night performance of a twenty-year-old, you should probably lower your expectations just a smidgen. If, on the other hand, you notice a sudden change in your performance or drive, or your sexual dysfunction is really interfering with your quality of life, keep reading this chapter.

  Make an Appointment

  You haven’t seen the doctor in a while. Erection problems can be the first sign of diseases like hypertension, high cholesterol, and diabetes. They can also be a warning sign of heart disease, as the same processes that clog the arteries to your heart can also clog the arteries to your penis, preventing it from fully engorging with blood. Let your physician know about erection problems, as they may prompt a thorough evaluation. If necessary, drugs like sildenafil/Viagra, vardenafil/Levitra, and tadalafil/Cialis help open those arteries back up again. If you feel like you’re depressed and have low energy, you may have a low testosterone level. Your doctor can order a blood test to check your level and, if necessary, prescribe testosterone replacement therapies.

  You have love handles. In addition to being utterly misnamed (does anyone really grab those things during sex?!), excess abdominal fat is associated with high levels of estrogen, which can in turn cause erectile dysfunction. Weight loss and exercise can improve your erections and libido. (Which is a good thing, since the new, slimmer you may feel more confident at the bar.) In the meantime, however, your doctor may want to check for other conditions that are associated with obesity and can damage the arteries that bring blood to the penis—like high blood pressure, high cholesterol, and diabetes.

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  Quick Consult

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  You Just Can’t Contain Yourself

  Premature ejaculation is an extremely common problem and the source of much distress and embarrassment. Of course, it’s hard to deliver a satisfying sexual experience to your partner if your rocket launches before the clothes come off.

  The good news is most men can hang on longer by following simple tips. First, try to engage in more foreplay—not only because it will prime your partner for climax, but because lower-stakes stimulation may relax your mind and desensitize you
r little friend. Second, try masturbating a few hours before intercourse so that your tank isn’t fully loaded. If you’re still finishing too quickly, try using thicker condoms (not the invisible or bare skin varieties). If those don’t help, try condoms or sprays that contain a small dose of anesthetic to desensitize the tip of your penis.

  If all else fails, ask your doctor about taking a selective serotonin reuptake inhibitor, or SSRI. This class of medications is typically used to treat depression but causes delayed ejaculation as a side effect. Perhaps it’s a side effect that you want.

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  It’s not me, it’s the medication. Many medications interfere with libido and erectile function. The most common ones are selective serotonin reuptake inhibitors, or SSRIs, which are used to treat depression (for example, sertraline/Zoloft, fluoxetine/Prozac, paroxetine/Paxil, citalopram/Celexa, escitalopram/Lexapro). Several blood pressure medications can also cause erection problems, the most common being beta blockers (atenolol, metoprolol, and other medications ending in “-lol”). As always, please speak to your doctor before stopping any medication. (This is a good place to mention that nicotine, marijuana, cocaine, alcohol, and heroin can also mess with your willy.)

  Your penis, like a good spy thriller, takes a sudden turn. An abnormal curvature of the erect penis, also known as Peyronie’s disease, occurs in about one in twenty men. This condition is caused by scarring thought to result from repeated small traumatic injuries to the penis. (You don’t have to be into bondage to get these injuries, by the way. A few misdirected thrusts can do it.) The curvature can cause pain during erections and the inability to have intercourse. See a urologist about treatment, which can include injections to remove the scar tissue (not as horrific as they sound).

  You have burning or pain with urination, defecation, and/or ejaculation; a frequent urge to pee; and difficulty maintaining urine stream. You may have a condition called chronic nonbacterial prostatitis (also known as chronic pelvic pain syndrome), which results from irritation of the prostate gland and the tubes connecting the bladder to the penis. Your doctor will likely prescribe anti-inflammatory medications and an alpha blocker to help reduce your symptoms. Though their benefits are uncertain, antibiotics may also be prescribed.

  Get to the E.R.

  You have sickle cell disease and a prolonged erection (more than two hours without stimulation). You need to get to the E.R. before permanent damage occurs. Priapism, the medical term for a prolonged erection, is named for the Greek god of fertility, Priapus, who always had a pants tent. The condition is particularly common in men with sickle cell disease because they have abnormally curved red blood cells that can clog up the vessels in the penis and prevent normal drainage.

  You are taking a medication for erectile dysfunction and have a prolonged erection. Didn’t you listen to the television advertisements? These pills are another possible cause of priapism, and you should get to the E.R. to avoid permanent damage. Other medications that can cause prolonged erections include chlorpromazine/Thorazine and trazodone (used to treat psychosis and depression, respectively).

  Part 6

  Bathroom Trouble

  Blood in Your Urine

  In the hallowed halls (and bathrooms) of medical schools, the common wisdom is that healthy urine should be clear enough to read newsprint through. By this, we do not mean that you should actually urinate on a newspaper (though you may be tempted, given recent news), but rather that a test tube of urine should be transparent. If it’s dark yellow, you’re probably dehydrated. Try drinking water until your pee is clear enough to read an iPhone accidentally dropped in the toilet.

  But what if your urine is pink, orange, red, or brown? Is that blood? Should you be freaking out?

  The medical term for blood in your urine is “hematuria.” The good news is that most discolored urine doesn’t contain actual blood, but rather some byproduct of your food or medicine that looks like blood. If a urine test indicates actual blood is present, and there’s no simple explanation, the next step is to find the source. The major possibilities include the kidneys, the bladder, and (in men) the prostate.

  So how should you approach this problem? Should you keep chugging water and pray your pee clears up? Or is it time to hustle over to the emergency room with a Thermos full of your urine sample?

  Take a Chill Pill

  You just chowed down a beet salad or borscht. You ate a healthy portion of beets for dinner, but before you can pat yourself on the back, you notice you’re peeing blood. If you look at your cutting board, however, you’ll get a clue about what’s actually going on.

  Beet pigment stains everything it touches. For centuries, beets were used to dye clothes (we assume purple was always in style), and even today it’s still used to dye foods. After eating beets, some pigment may get absorbed into your blood and color your urine. Any pigment not absorbed by your intestines ends up in your stool, turning it dark red.

  Interestingly, people with iron-deficiency anemia are more likely to absorb beet pigment into their blood, so if you’re feeling short of breath and find that beets are turning your pee redder than usual, get tested for anemia.

  It’s that time of the month. In almost all cases, your urine is just being contaminated with menstrual blood. Sometimes a drop or two gets into the toilet, coloring the whole bowl, or some blood gets onto the opening of the urethra, contaminating urine on its way out. In rare cases, women can develop uterine tissue inside the bladder, a condition known as endometriosis (page), producing bloody urine during menstruation.

  You’re taking phenazopyridine/Pyridium for a urinary infection. This medication helps ease the sting of a bladder infection, and as an added bonus it turns your urine orange or red. You might stain a few pairs of underwear (try switching to black ones for the week), but you’re not actually bleeding.

  You’re taking rifampin. This medication, used to treat severe infections like MRSA and tuberculosis, has the curious side effect of turning all of your bodily secretions orange. That’s right: orange pee, orange saliva, orange tears, even orange sweat. Try convincing your friends you’ve been possessed by a demon (they may not be surprised).

  You just ran a marathon. Nearly one in four individuals experience bloody urine after intense aerobic exercise, like long-distance running or swimming. Doctors don’t know why it occurs, but it hasn’t been linked to long-term kidney problems. If your muscles are really hurting after an intense workout, however, you could have a different condition called rhabdomyolysis (muscle breakdown). The damaged muscle fibers release chemicals that color the urine brown and can also cause kidney failure. This condition is serious and warrants a trip to the E.R.

  Make an Appointment

  You recently had a sore throat. One rare complication of sore throat is an autoimmune attack on the kidneys—who are all like, “Why did you bring us into this?!” The kidney problems can begin days to weeks after the sore throat. The most severe cases can be associated with face/leg swelling, high blood pressure, and kidney failure. Fortunately, this complication is very rare. It’s more likely you ate beets and forgot.

  You look like the Michelin man. The combination of red urine and body swelling, particularly in the face and legs, strongly suggests kidney damage. The struggling kidneys can’t get rid of fluid fast enough, so it instead ends up under your skin. The kidneys also fail to keep blood out of your urine. You need an urgent evaluation to identify the cause and begin treatment.

  You take lots of pain medicine. If you take pain medications known as NSAIDs (ibuprofen/Advil/Motrin, naproxen/Aleve/Naprosyn, aspirin) for a long time at high doses, you could experience severe kidney damage. In some cases, the first symptom is bloody urine. If you’re one of the many people with chronic pain, consult with your doctor to find a long-term treatment plan that’s both safe and effective.

  You take a blood thinner. If you have heart disease or a history of blood clots, you might be on a blood thinner like warfarin/Coumadin, apixaban/Eliquis
, rivaroxaban/Xarelto, or dabigatran/Pradaxa (or related drugs like ticagrelor/Brilinta, prasugrel/Effient, and clopidogrel/Plavix). One inevitable consequence of these drugs is the increased risk of blood coming out of your . . . wherever. Sometimes the bleeding is from a minor issue, like a tiny burst vessel in your bladder, that wouldn’t have shown up without the blood thinner. Sometimes, however, the bleeding is from a problem that requires immediate attention, like a tumor. (In this case, the blood thinner may have saved your life, by revealing the problem early.) You’ll need a full evaluation to determine the source of bleeding.

  You’re a man, and your pee dribbles out. You likely have an enlarged prostate. The prostate gland wraps around the urethra (the tube that drains urine from the bladder) just before it exits the body in the penis. As the prostate gets bigger, the urethra gets squeezed, and you have to generate more effort to force urine through. The enlarged prostate can bleed into the urethra, turning your urine red. You’ll probably need tests to rule out a bladder or prostate tumor, less likely explanations that shouldn’t be missed.

  You’re over the age of fifty. There may be a perfectly innocent explanation for your bloody urine, but your age puts you at increased risk of cancer. (If you’re a current or former smoker, the risk of bladder cancer is particularly high.) You’ll need a thorough evaluation, likely including a cystoscopy. In this procedure, a urologist inserts a small camera into the bladder to check for tumors.